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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197411145
Report Date: 10/07/2022
Date Signed: 10/07/2022 03:45:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/14/2022 and conducted by Evaluator Denise Miranda
COMPLAINT CONTROL NUMBER: 58-CC-20220914151134
FACILITY NAME:DVORSKAYA ALTERNATIVE SCHOOLFACILITY NUMBER:
197411145
ADMINISTRATOR:MUKHURADZE, JINAFACILITY TYPE:
850
ADDRESS:1317 N. CRESENT HEIGHTS BLVD.TELEPHONE:
(323) 822-7999
CITY:WEST HOLLYWOODSTATE: CAZIP CODE:
90046
CAPACITY:41CENSUS: 7DATE:
10/07/2022
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Jina Mukhuradze, Director TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility did not follow mandated reporting requirements.
Facility staff are not adequately trained.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced complaint inspection to the above facility on 10/07/22. LPA arrived at 2:10PM and met with Jina Mukhuradze, Director, who guided analyst on a tour of the facility. There were 07 children with 02 Staff and Director upon arrival.
During the investigation LPA interviewed staff, obtained a copy of the children's roster, obtained copies of supporting documentation.
Information provided by the reporting party indicates Facility did not follow mandated reporting requirements and Facility staff are not adequately trained.
When interviewing the Director, Staff #2, Staff #4 and Staff #5, disclosures were made that they were not aware about the mandated reporter training, how to obtain the proof of completion for the training, or that it shall be renewed every 2 years. In addition, Director and Staff were not aware, who they should report to when they suspect child abuse and/or neglect.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 58-CC-20220914151134
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DVORSKAYA ALTERNATIVE SCHOOL
FACILITY NUMBER: 197411145
VISIT DATE: 10/07/2022
NARRATIVE
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During a previous visit, on 9/23/2022, LPA provided consultation about being a mandated reporter which included the website, a copy of the Health and Safety Code: 1596.8662, and a brochure of Mandated Reporter information. LPA also obtained copies of the LIC 9108 Statement Acknowledging Requirement to Report Child Abuse that are part of the required forms to obtain and file in each staff records.
LPA attempted to interview children in care, but children were not fully verbal.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Per Health & Safety Code 1596.8662,
facility is being cited on the attached deficiencies page.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Jina Mukhuradze, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 58-CC-20220914151134
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DVORSKAYA ALTERNATIVE SCHOOL
FACILITY NUMBER: 197411145
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2022
Section Cited
CCR
1596.8662(b)
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H&S §1596.8662 - (B) Reporting requirements for child abuse and neglect, including guidelines on how to make a suspected child abuse report when suspected abuse or neglect takes place outside a child day care facility, or within a child day care facility, and to which enforcement agency or agencies a report is required to be made.
This requirement is not met as evidenced by:
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Director, will conducted a training with all Staff and will provide A copy of the Agenda sign by all Staff, regarding Mandated Report, Reporting requirement. Director will submit via email to LPA Miranda no later than 10/14/2022. During this visit, LPA obtained a
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Based on record review, the
Licensee did not comply with the section cited above. Director and Staff were not aware, who they should report any abuse and neglect, how to make a suspected child abuse report when suspected abuse or neglect takes place inside or outside of the child day care facility, which poses a potential health, safety or personal rights risk to persons in care.
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declaration from Director. Per Director, she understand and she will make sure all her staff understand that any suspect child abuse, or any child abuse or neglect shall be report to Department of Social Services and enforcement agency. In addition, Director will submit proof of completion of Mandated Reporter to Staff#2,#5 and #7 via email.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC9099 (FAS) - (06/04)
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