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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415810
Report Date: 09/07/2022
Date Signed: 09/07/2022 01:36:35 PM


Document Has Been Signed on 09/07/2022 01:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:UMANSKY, SVETLANAFACILITY NUMBER:
434415810
ADMINISTRATOR:UMANSKY, SVETLANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 224-6693
CITY:SAN JOSESTATE: CAZIP CODE:
95130
CAPACITY:14CENSUS: 8DATE:
09/07/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Svetlana UmanskyTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA), Marilou Monico, met with Licensee, Svetlana Umansky, for a Plan of Correction Inspection. The facility was cited on September 1, 2022 under Staffing Ratio and Capacity, and Infant Safe Sleep. Also present in the home were Licensee's two adult assistants and eight (8) daycare children including four (4) infants and four (4) preschool age.

During today's inspection, LPA observed the following:
1) Three adults and eight (8) daycare children (4 infants and 4 preschool age)
2) Completed and signed Acknowledgement of Receipt of Licensing Report forms

Licensee submitted sleep log and written plan of correction on September 2, 2022 via email.

Deficiencies under Staffing Ratio and Capacity and Infant Safe Sleep are hereby corrected and cleared.

There were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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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