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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416875
Report Date: 04/17/2024
Date Signed: 04/17/2024 11:06:06 AM

Document Has Been Signed on 04/17/2024 11:06 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ATABEKOVA, ZHANNAFACILITY NUMBER:
434416875
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/17/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Zhanna AtabekovaTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Mel Matos met with Zhanna Atabekova, Applicant, for an unannounced prelicensing inspection. The San Jose Child Care District Office received an Application for a small Family Child Care License on February 2, 2024. Notification of Incomplete Application - Family Child Care Home (LIC 184B) was mailed to the Applicant on February 6, 2024 and March 13, 2024.

A copy of the lease was emailed to LPA during today's inspection. Zhanna states that her son and daughter-in-law are noted on the lease, but no longer reside in the home. Zhanna states that they will remain on the lease since they helped her qualify to rent the home.

Zhanna understands that her son and daughter-in-law need to obtain criminal record and child abuse index clearances along with a TB test (within the past 12 months) before a prelicensing inspection of the home can be scheduled. A copy of the Request for Live Scan Service (LIC 9163) was provided to Zhanna during today's inspection.

Zhanna agreed to submit a copy of the Request for Live Scan Service (LIC 9163) forms and TB test to LPA by Friday April 26, 2024.

Failure to complete to obtain criminal record and child abuse index clearances along with a TB test for her son and daughter-in-law by Friday April 26, 2024 will require that the Applicant withdraw her pending application for a small Family Child Care Home license.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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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