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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197411821
Report Date: 06/06/2019
Date Signed: 06/06/2019 01:15:46 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/13/2019 and conducted by Evaluator Peter Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20190313181305
FACILITY NAME:DVORSKAYA ALTERNATIVE SCHOOL SCHOOL AGE CENTERFACILITY NUMBER:
197411821
ADMINISTRATOR:NONNA DANILKEVICHFACILITY TYPE:
840
ADDRESS:1317 CRESCENT HEIGHTS BLVD.TELEPHONE:
(323) 822-7999
CITY:W. HOLLYWOODSTATE: CAZIP CODE:
90046
CAPACITY:30CENSUS: DATE:
06/06/2019
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Jina Mukhuradze - Director TIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
OTHER:
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/06/2019, at 11:45 AM, Licensing Program Analyst (LPA) Peter Flores conducted an unannounced visit for the purpose of concluding a complaint investigation. LPA met with the Director Jina Mukhuradze who guided LPA on a tour of the facility. There were no children or staff in facility. School Age program starts at 2:00 PM. On 03/14/19, LPA interviewed Director and Staff. LPA obtained copy of facility roster and other supporting documents.

Based on observations and information gathered throughout the course of the investigation, there was insufficient evidence to determine whether the incident occurred or not. Therefore, the allegation is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
An exit interview was conducted a copy of this report was given to Director Jina Mukhuradze.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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