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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197493596
Report Date: 12/09/2021
Date Signed: 12/09/2021 03:19:18 PM

Substantiated


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
12/02/2021 and conducted by Evaluator Margarit Sislyan
COMPLAINT CONTROL NUMBER: 30-CC-20211202113127
FACILITY NAME:STOLYAROVA FAMILY CHILD CAREFACILITY NUMBER:
197493596
ADMINISTRATOR:STOLYAROVA, ALINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 921-2540
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:14CENSUS: 9DATE:
12/09/2021
UNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Alina StolyarovaTIME COMPLETED:
03:32 PM
ALLEGATION(S):
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9
Licensee did not notify parents of hand foot and mouth disease at facility
INVESTIGATION FINDINGS:
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13
Margarit Sislyan, Licensing Program Analyst (LPA) arrived at the facility to investigate the above allegation. LPA met with Licensee, Alina Stolyarova. LPA toured the facility and observed 9 children were present along with licensee and her husband, Evgeny Nagovitsin.

During the investigation LPA interviewed parties and reviewed documents relevant to the allegation.

Based on LPA's observation the above allegations are substantiated, means that the allegation is valid because the preponderance of the evidence standard has been met.
Facility was cited Type B deficiency. See complaint investigation report LIC9099 D.

Exit interview
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE:
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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 2
Control Number 30-CC-20211202113127
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: STOLYAROVA FAMILY CHILD CARE
FACILITY NUMBER: 197493596
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/09/2021
Section Cited
CCR
102423(a)(2)
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Personal Rights
Each child receiving services from a family child care home shall have certain rights…To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
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Licensee shall review Title 22 regulations regarding Personal Rights and Reporting requirements.
Send a declaration to CCLD stating that the above regulations were reviewed.

POC Date 12/19/2021
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14
Based on interviews Licensee did not notify parents of hand foot and mouth disease at facility
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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: Mary RuizTELEPHONE:
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2