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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415675
Report Date: 04/05/2023
Date Signed: 04/05/2023 10:32:20 AM


Document Has Been Signed on 04/05/2023 10:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:BASHIROVA, LIUDMILAFACILITY NUMBER:
434415675
ADMINISTRATOR:BASHIROVA, LIUDMILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 657-3157
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:14CENSUS: 12DATE:
04/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Liudmila BashirovaTIME COMPLETED:
10:55 AM
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On 4/5/2023, Licensing Program Analyst (LPA) Pete Hernandez met with Licensee, Liudmila Bashirova, and conducted an unannounced Required 1 year inspection. LPA explained the nature of today's inspection to her. In the home during today's inspection were Licensee, her husband Dimitry Semenov, their minor child, Helper Yuliya Malobava, and 12 preschool age children. There are two adults: Licensee, her husband and two minor, one is over 10 years of age living in the home.

Days and hours of operation are Monday thru Friday from 9:00 AM to 6:00 PM. Licensee carries day care general liability insurance.

LPA reviewed 10 children's files and toured the indoor and outdoor areas of the home during today's inspection. Off limit areas in the home: room 2, room 3, master bedroom, master bathroom, one bathroom, kitchen, and garage. Off limit areas outside the home: locked storage shed. LPA observed a properly fenced self - closing swimming pool. Licensee understands that children shall be supervised at all times when using the backyard. Licensee has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and fire pull stations. The back yard is fenced backyard. Applicant stated that there are weapons in the home. LPA observed one firearm locked up in safe separate from ammunition. Cleaning products, medications and sharp objects were inaccessible to children. LPA informed Licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes.

The Licensee states that she does not transport children and understands that children cannot be left in parked vehicles unattended at any time. Licensee understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat-related illnesses, and requirements for assistant/substitute were also discussed.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 4/5/2023:
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BASHIROVA, LIUDMILA
FACILITY NUMBER: 434415675
VISIT DATE: 04/05/2023
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 4/5/2023):

LPA informed the Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Supervision of children was discussed with the Licensee. Licensee understands that she must be present in the home at least 80 percent of the hours the day care is in operation and ensure that the children are supervised at all times. The Licensee understands her capacity options. The Licensee states that she does not transport children and understands that children cannot be left in parked vehicles unattended at any time. Licensee understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat-related illnesses, and requirements for assistant/substitute were also discussed.



LPA informed Licensee that Licensing forms and Title 22 regulations, Orientation for Child Care Centers, can be obtained through the internet at www.ccld.ca.gov.

Last fire drill was conducted on 4/4/2023. LPA informed Licensee that fire/disaster drills must be practiced at least once every six months and documented. Licensee is compliant.

Licensee's Mandated Reporter certificate is current and scheduled to expired 5/31/2024.
Licensee's Helper Yuliya Malobava does have a Mandated Reporter Certificate available.

Licensee has a current CPR/ First Aid Certificate that expires 8/14/23.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BASHIROVA, LIUDMILA
FACILITY NUMBER: 434415675
VISIT DATE: 04/05/2023
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LPA went over Reg 102425(j) and (j)(2)(D) regarding infant care and LIC 9227 (Infant Sleeping Plan). LPA Provided a copy. The provider shall supervise infants while they are sleeping.

LPA observed all required postings on the wall next to the front door.

Upon the issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. A copy of this report and appeals rights were discussed and left with the Licensee, Liudmila Bashirova, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC809 (FAS) - (06/04)
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