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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416382
Report Date: 04/24/2023
Date Signed: 04/24/2023 03:44:59 PM

Document Has Been Signed on 04/24/2023 03:44 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SKVORTCOVA, ELENAFACILITY NUMBER:
434416382
ADMINISTRATOR:SKVORTCOVA, ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 667-2985
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
04/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Elena SkvortcovaTIME COMPLETED:
03:50 PM
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Licensing Program Analysts (LPAs), Marilou Monico, and Ashley Lopez, met with Elena Skvortcova and made an unannounced Case Management Inspection to deliver the Decision and Order with an effective date of February 24, 2023. Aso present in the home were Elena's husband and her three children ages, 16, 8, and 5 years old. The Decision and Order indicates that Elena's Skvortcova's license to operate a family child care home located at 1984 Bernice Way, San Jose, California is revoked. Elena Skvortocova is prohibited from employment in, presence in, and contact with clients of, any facility licensed by the Department, certified or approved by a licensed foster family agency, or any resource family home, and from holding a position of member of the board of directors, executive director, or officer of the licensee of any facility licensed by the Department, for the remainder of her life.

LPAs did not observe any children in care during the inspection. Elena stated that she's no longer operating her daycare.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2023
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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