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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004964
Report Date: 02/13/2025
Date Signed: 02/13/2025 01:04:06 PM

Document Has Been Signed on 02/13/2025 01:04 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SKOBA, SVITLANAFACILITY NUMBER:
414004964
ADMINISTRATOR/
DIRECTOR:		SKOBA, SVITLANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 445-1385
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
02/13/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Svitlana SkobaTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On February 13, 2025 @ approx. 11:45am, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced, plan of correction (POC) visit and met with license, Svitlana Skoba. Present during today’s visit were licensee, helper H3), and 8 children (3 infants and 5 preschoolers). LPA toured facility for health and safety hazards.

On January 16, 2025, LPA Maria Olguin-Leon conducted an annual inspection visit and issued a Type A deficiency for an adult working at the facility with no criminal background clearance. A plan of correction (POC) was developed with helper (H1) and licensee. On January 28, 2025, LPA conducted a POC visit and issued failure to correct, as H2 was present at facility with no criminal background clearance. LPA issued a deficiency for not posting report and incomplete LIC 9224’s.

During today’s visit, LPA reviewed LIC9224 Acknowledgement of Receipt of Licensing Reports, which were signed and completed for 10 enrolled children. LPA observed notice of site visit posted and report dated January 16, 2025, to be posted as is required for a type A deficiency. H2 was not present during today's visit.

Deficiency issued on January 16, 2025, and January 28, 2025, have been cleared as of today. LPA confirmed H2 has been cleared on Guardian and has criminal background clearance. LPA informed Licensee of H2 clearance status.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with licensee, Svitlana Skoba. Report was translated in Russian by agent #AQ657.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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