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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416371
Report Date: 12/20/2023
Date Signed: 12/20/2023 07:22:58 PM

Document Has Been Signed on 12/20/2023 07:22 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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MANKOVSKAJA, LUDMILAFACILITY NUMBER:
434416371
ADMINISTRATOR:MANKOVSKAJA, LUDMILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 656-7685
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
12/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ludmila NankovskajaTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced 10-day investigation at the facility today and met with the licensee, Lumila Mankovskaja. Present during the investigation were the licensee, her daughter (helper) and 6 children. The facility had an annual inspection on 9/6/23, when the licensee had 3 children. LPA reviewed the required documents for the 6 children and the helper.

The helper did not have mandated reporter training certificate. C1 does not have the consent for emergency medical treatment. Citations were issued accordingly. The licensee did not maintain a roster of children in care.

This report and plan of corrections were reviewed with the licensee, Ludmila Mankovskaja.

Appealing right and notice of site visit were provided via email MILA.MANKOVSKI@GMAIL.COM due to technical issues.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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Document Has Been Signed on 12/20/2023 07:22 PM - It Cannot Be Edited


Created By: Sheena Chin On 12/20/2023 at 03:44 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MANKOVSKAJA, LUDMILA
FACILITY NUMBER: 434416371

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/29/2023
Section Cited
HSC
1596.8662(b)(1)

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On or before March 30, 2018, a person who ... employed of a licensed child day care facility shall complete the mandated reporter training...

The helper does not have the mandated reporter training certificate.
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The licensee will have the helper complete the mandated reporter training and send the copy of the certificate
Type B
12/29/2023
Section Cited
CCR
102417(g)(8)

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Each family child care home shall have a current roster of children...


The licensee did not maintain a current roster of children in care.
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The licensee will send LPA the copy of the roster of children in care.

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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.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Sheena Chin
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2023


LIC809 (FAS) - (06/04)
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