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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005005
Report Date: 09/15/2026
Date Signed: 09/15/2026 04:40:48 PM

Document Has Been Signed on 09/15/2026 04:40 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:ZHAMBALOVA, LILIAFACILITY NUMBER:
414005005
ADMINISTRATOR/
DIRECTOR:		ZHAMBALOVA, LILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 480-9979
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
09/15/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:56 PM
MET WITH:Lilia ZhambalovaTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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On September 15, 2026, at approximately 2:00 pm, Licensing Program Analyst (LPA) Maria Olguin-Leon met with Licensee Lilia Zhambalova to conduct an unannounced annual inspection. The purpose of the inspection visit was explained to Licensee. Present during today’s visit was licensee and two assistants caring for 12 children (4 infants & 8 preschoolers). A1 left facility and license spouse arrived at facility. A2 and spouse have criminal background clearances. Licensee is in compliance with ratio capacity requirements. Hours of operation are Monday – Friday from 8:00 am to 5:30 pm.

Licensee maintains Childcare License and Parent's rights posted at entrance of home. Emergency Disaster Plan (LIC610A) was reviewed and maintained in files. LPA provided Licensee with Earthquake Preparedness Checklist. Last emergency drill was conducted on February 7, 2026, and is properly documented with date. LPA reminded Licensee emergency drills are to be conducted every six-month, type B citation issued for this deficiency.

LPA observed pull down fire alarm in living room (#1). A fully charged fire extinguisher was observed hanging on dining room wall and is easily accessible. Licensee keeps a fully stocked first aid kit. Dual smoke/carbon monoxide detector was tested during today’s visit and observed to be in working condition. Licensee maintains a cell phone service on the premises. Per Licensee, there are no weapons or firearms in the home.
LPA inspected the indoors and outdoors of home for health and safety hazards. LPA observed home to be free of defects or conditions that might endanger a child. Home is a one-story dwelling, with 4 bedrooms and 2 bathrooms. Daycare areas are: Entrance foyer, living room (#1), family room (2), bathroom in hallway, bedroom #1 and backyard. Off-limit areas are: Bedroom #2, #3 and #4, master bathroom, kitchen/dining room (walk through only), and garage. Isolation area: Sick children will be isolated in entrance foyer and away from other children. LPA observed bedroom #3 and #4 being used as daycare areas for napping purposes, as these rooms are designated as off limits, a type B citation was issued for this deficiency. LPA advised Licensee to submit an updated application with facility sketch requesting off limits bedrooms to be adding to daycare areas of license.

Cont. page 2...
Marie Rodriguez
Maria Olguin-Leon
DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ZHAMBALOVA, LILIA
FACILITY NUMBER: 414005005
VISIT DATE: 09/15/2026
NARRATIVE
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Home has proper heating, lighting and ventilation to provide safety and comfort. LPA observed age-appropriate toys, learning material, toy storage cubbies, child size furniture, and books, all in good condition. LPA observed hooks in entrance foyer for children to store their personal belongings.

LPA observed childproof gate between kitchen/dining room and family room (2). Off Limits rooms are maintained off limits with closed doors. Electrical outlets are secured with childproof covers and barricaded with furniture. LPA observed foam mats in family room to absorb and cushion falls. LPA observed a fireplace mantel with high fireplace covered with curtains.

Bathroom was clean and cabinet was secured with childproof latch. LPA observed potty-training chair available for potty-training purposes in family room. A changing mat was observed for diapering infants. Cleaning supplies and other potentially harmful items are stored inaccessible to children.

LPA observed toddler size beds in bedroom #3 and playpens in bedroom #4 for napping purposes. LPA observed an infant sleeping in a sleep sack, which are banned for use in daycare, type B citation issued for this deficiency. Mattresses on toddler beds and playpens were observed to be firm and covered with a tight-fitting sheet. Licensee provides sheets and bedding, and sheets/bedding are washed on a weekly basis or as needed. 15-minute sleep logs were reviewed and are being properly maintained for all enrolled infants.

Backyard is completely enclosed and surrounded by a 5 ft wood fence. LPA observed a small slide play structure, ride on toys, play tunnel, dome climbing structure and other age-appropriate outdoor toys, all in good condition. Side of yard was observed to have a gate for inaccessibility. Flooring in backyard is artificial grass to absorb and cushion falls. LPA observed sunshades outdoors for providing shade to children in care. LPA did not observe any pool, spas, or other bodies of water

Licensee provides meals for children in care which includes breakfast, lunch, and am/pm snacks. LPA reminded licensee that any food brought from home must be labeled and stored properly. LPA observed booster chairs on floor and child size table and chairs for child to sit and eat. LPA observed kitchen to be clean, and food properly stored to avoid contamination or spoilage. LPA observed children’s water bottles labeled with children’s name.

Cont. page 3...
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
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 BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ZHAMBALOVA, LILIA
FACILITY NUMBER: 414005005
VISIT DATE: 09/15/2026
NARRATIVE
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LPA reviewed 6 children’s files and 1 assistant file; all files were complete. LPA reviewed children’s roster, LPA reminded licensee to maintain roster up to date, and technical assistance provided. Licensee’s CPR/FA expiration date is 7/2028 and licensee’s Mandated reporter expires 06/2027.

Licensee Lilia Zhambalova was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Lilia Zhambalova and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Lilia Zhambalova of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Cont. page 4...
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC809 (FAS) - (06/04)
Page: 8 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ZHAMBALOVA, LILIA
FACILITY NUMBER: 414005005
VISIT DATE: 09/15/2026
NARRATIVE
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Licensee Lilia Zhambalova was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed AB 1207 with the Licensee.

During the exit interview, the Licensee Lilia Zhambalova, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

See page LIC809D for deficiencies issued at time of LPA's visit, under title 22.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Lilia Zhambalova. Appeal Rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 09/15/2026 04:40 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 09/15/2026 at 04:00 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ZHAMBALOVA, LILIA
FACILITY NUMBER: 414005005

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in last emergency drill was conducted over 6 months ago, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2026
Plan of Correction
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Licensee will conduct an emergency drill by POC due date and send LPA a video of drill being conducted.
Type B
Section Cited
CCR
102425(f)
Infant Safe Sleep
An infant shall not be swaddled while in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above in an infant was observed sleeping in a sleep sack which is considered as a form of swaddling, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/17/2026
Plan of Correction
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Licensee will no longer use sleeping sack on infant children and will inform parents that sleep sacks are not allowed in licensed daycares.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Maria Olguin-Leon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2026


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 09/15/2026 04:40 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 09/15/2026 at 04:00 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ZHAMBALOVA, LILIA
FACILITY NUMBER: 414005005

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in two off limits bedrooms were being used for daycare purposes, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2026
Plan of Correction
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Licensee will submit an updated LIC279 childcare application, facility sketch and request to add off limits bedroom to daycare areas for napping purposes.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Maria Olguin-Leon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2026


LIC809 (FAS) - (06/04)
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