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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417426
Report Date: 11/20/2024
Date Signed: 11/20/2024 03:24:07 PM

Document Has Been Signed on 11/20/2024 03:24 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:ALIYEVA, YEGANAFACILITY NUMBER:
434417426
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 1CENSUS: 1DATE:
11/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Yegana AliyevaTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Mel Matos met with Yegana Aliyeva, Licensee, for an unannounced case management inspection. LPA also observed Licensee's spouse and one infant day care child in the home during today's inspection.

LPA reminded the Licensee that she must have a file for each child(ren enrolled in the day care; regardless if the child(ren) is enrolled on a "trial" basis or not. LPA provided a packet of forms required for each enrolled child to the Licensee.

LPA also provided a blank copy of the Child Care Facility Roster (LIC 9040) and Infant Sleep Log to the Licensee.

Exit interview conducted and report was reviewed with the Licensee, Yegana Aliyeva. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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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