<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005005
Report Date: 05/15/2023
Date Signed: 05/15/2023 10:53:50 AM

Document Has Been Signed on 05/15/2023 10:53 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 BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ZHAMBALOVA, LILIAFACILITY NUMBER:
414005005
ADMINISTRATOR:ZHAMBALOVA, LILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 480-9979
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/15/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lilia ZhambalovaTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 15, 2023, at 9:00AM, Licensing Program Analyst (LPA)Maria Olguin-Leon, conducted an announced, pre-licensing relocation inspection. LPA met with applicant, Lilia Zhambalova and explained the purpose of the inspection. Applicant submitted a relocation application to our department on April 14, 2023. Applicant has relocated from Facility #414004950 to this location. Hours of operation will Monday-Friday from 8:00AM to 5:30PM. Fire Department approved fire clearance on May 10, 2023.

With applicant, LPA inspected the indoors and outdoors of the home, for health and safety hazards. The home is a single level home with 4 bedrooms, 2 bathrooms, 2 living rooms, dining room, kitchen & garage. The DAY CARE AREAS are the living rooms, bedroom #1, bathroom #1, and backyard. The OFF-LIMIT AREAS are bedrooms #1, #2, and #3, dining room, kitchen, and garage. Kitchen and dining room are walk through area to living room #2 and backyard. Off limits hallway and bedrooms are properly barricaded with childproof gate. Applicant was notified any off-limit areas are not to be used as a day care area without prior approval from department.

LPA observed the following: Home was clean and orderly. There are plenty of age-appropriate toys, books, child size tables, chairs, beds, and playpens. Closets, cabinets are all locked and inaccessible with locks or outlets covers. Living room #2 includes a fireplace that is properly barricaded and made inaccessible to children.

Home has ventilation and lighting throughout. Home has a functioning smoke detector and carbon monoxide detector and fire extinguisher.. All detergents, cleaning compounds, medications and other items which could pose a danger will be stored inaccessible to children behind child safety locked cabinets and/or located in off limit areas. Per applicant, home does not have any no guns or weapons. Outdoor is completely fenced with artificial grass for cushioning falls. Sides of backyard are properly barricaded with child proof gates.


Continued page 2....
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ZHAMBALOVA, LILIA
FACILITY NUMBER: 414005005
VISIT DATE: 05/15/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Cont. Page 2...

Applicants plans to provide meals (breakfast, lunch & two snacks). Applicant has liability insurance via Accord. A designated cell phone will remain home during daycare hours.

LPA reviewed the LIC311D, Records to Keep in Your Family Child Care Home, children’s forms/ records, facility forms, and information to be posted. Applicant is registered for CPR/First Aid and will email a copy of certification to LPA. Applicant Mandated Reporter training certificate (AB1207) is current that will expire 05/2025.

LPA and applicants discussed licensing regulations and the capacity requirements. Any children under 10 years of age that live in the home, will be counted in overall capacity. Applicants were advised that all food containers brought from home must be properly stored and labelled. Applicants plan to provide a food service if necessary. Children also have the option to provide their own meals. LPA discussed sanitation and allergies with applicants.

Applicants understand the required emergency disaster drills are to be conducted and documented at least once every six months. Applicants understand that the use of baby walkers, bouncers, jumpers, and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home.

Applicants were reminded 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 for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Applicants were reminded that all adults 18 years and over living or working in the home, including employee and volunteers, must obtain criminal 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 up to $500.00 maximum per day/ per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ZHAMBALOVA, LILIA
FACILITY NUMBER: 414005005
VISIT DATE: 05/15/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
cont. page 3...

LPA discussed the safe sleep regulations with applicants and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed the applicants of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility plans to provide Incidental Medical Services-IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform. To receive important license-related information to licensed facilities, visit the CCLD important information website at https://www.cdss.ca.gov/inforesources/community-care-lciensing/subscribe and select the Child Care option to receive email communication.

Large Family Child Care Provisional License is approved and will be effective as today, 05/16/2023

-Applicant will complete and submitted CPR/First Aid certification to .

-Purchase a first aid kit

-Secure cables outside.

Exit interview conducted and report was reviewed with the applicant, Lilia Zhambalova.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3