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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013418512
Report Date: 03/10/2021
Date Signed: 03/22/2021 09:46:43 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/27/2021 and conducted by Evaluator Renee Reed
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210127161156

FACILITY NAME:YAROSHEVSKAYA, ANNAFACILITY NUMBER:
013418512
ADMINISTRATOR:YAROSHEVSKAYA, ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 828-3071
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:12CENSUS: 9DATE:
03/10/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Anna YaroshevskayaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Physcal Plant - Licensee did not keep the facility grounds clean.
Physcial Plant - Facility has Rodents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Due to Consistency Check in FAS, LPA Reed typed Complaint Investigation Report on hand written LIC 9099 form and received wet signature from Licensee on form.

On 3-10-2021) at approximately !0:45 AM, Licensing Program Analyst (LPA) Renee Reed , conducted an unannounced complaint investigation to deliver findings of the above allegation. LPA met with Licensee Anna Yaroshevskaya, also present was 8 pre-schoolers, 1 infant, Assistant Kiseleva and husband Yaroslav. Based on the interview and observation conducted of the facility grounds inside and outside, this agency has investigated the complaint Although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. This report shall remain on file for 3 years. A Notice of Site Visit was provided and must remain posted for 30 days. Exit interview conducted with Anna Yaroshevskaya. Copy of report provided, due to consistency appeal rights will be forwarded. Appeal rights were given at initial visit on 2/4/2021.
Unsubstantiated
Estimated Days of Completion: 60
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee ReedTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2