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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197493251
Report Date: 05/03/2019
Date Signed: 05/06/2019 09:06:07 AM



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
05/01/2019 and conducted by Evaluator Margarit Sislyan
COMPLAINT CONTROL NUMBER: 30-CC-20190501142040

FACILITY NAME:PERESECHANSKAYA FAMILY CHILD CAREFACILITY NUMBER:
197493251
ADMINISTRATOR:YERESECHANSKAYA, ZHANNETAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 800-0911
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:14CENSUS: 9DATE:
05/03/2019
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Zhanneta PeresechanskayaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Facility is over ratio
INVESTIGATION FINDINGS:
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Margarit Sislyan, Licensing Program Analyst (LPA) arrived at the facility to investigate the above allegations.
LPA met and interviewed licensee and her assistant.
Upon arrival LPA observed 9 children were present with Licensee’s assistant. Licensee arrived little later.
Based on LPA, observation and the investigation conducted and preponderance of evidence the above allegation is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Exit interview
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (424) 302-3048
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: ((42) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 30-CC-20190501142040
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: PERESECHANSKAYA FAMILY CHILD CARE
FACILITY NUMBER: 197493251
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/03/2019
Section Cited
CCR
102416.5(d)
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For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home

Upon arrival on 5/3/19 LPA observed there were 9 chidlren present at home with one adult assistant.
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No more than 8 children shall be under the care of one qualified person (Licensee or qualified assistant) at any time.

POC date 05/03/19
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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.
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (424) 302-3048
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: ((42) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
LIC9099 (FAS) - (06/04)
Page: 4 of 4