197494680-10-8-2021-30-CC-MRUZ-C7QKS8-20211012080906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197494680
Report Date: 10/08/2021
Date Signed: 10/08/2021 01:24:19 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
08/17/2021 and conducted by Evaluator Silva Garibyan

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20210817173500

FACILITY NAME:	SKRYPNYK SHEVCHUK FAMILY CHILD CARE		FACILITY NUMBER:	197494680
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	10/08/2021
		UNANNOUNCED	TIME BEGAN:	11:21 AM
MET WITH:	Larysa Shevchuk/Licensee		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Advertisements and License Number: Facebook advertisement is missing the license number.

INVESTIGATION FINDINGS:

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On October 8, 2021 at 11:10 am, Licensing Program Analyst (LPA) Silva Garibyan, conducted an unannounced site visit to the licensed facility for the purpose of delivering the findings. LPA met with Larysa Shevchuk/Licensee and explained the purpose of the visit. Licensee was present with 6 children ( including one infant, licensee's grandsont).
During the Complaint investigation, interviews were conducted, and observations were made regarding the allegation. During complaint investigation, LPA observed a Facebook advertisement which was missing the license number.

Based on LPA's observation, interviews conducted, and records reviewed the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED according to the California Code of Regulations, Title 22, Division 12, Chapter 1, Section 102359(a). A copy of this report, Appeal Rights, and Notice of Site Visit were explained and provided to the Site Supervisor Jenny Chavez.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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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Control Number 30-CC-20210817173500

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: SKRYPNYK SHEVCHUK FAMILY CHILD CARE	FACILITY NUMBER: 197494680
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/22/2021 Section Cited CCR 102359(a)	1 2 3 4 5 6 7	Advertisements and License Number Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients. This requirement is not met as evidenced by:The Facebook advertisement was missing the license number which	1 2 3 4 5 6 7	Licensee agrees to add the license number on all advertisements, publications or announcements with the intent to attract clients and provide the Department with a written statement on how she will comply with this requirement by the POC due date (10/22/2021).
	8 9 10 11 12 13 14	poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
08/17/2021 and conducted by Evaluator Silva Garibyan

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20210817173500

FACILITY NAME:	SKRYPNYK SHEVCHUK FAMILY CHILD CARE		FACILITY NUMBER:	197494680
ADMINISTRATOR:	ANTON SKRYPNK		FACILITY TYPE:	810
ADDRESS:	6825 NEVADA AVE		TELEPHONE:	(818) 946-4979
CITY:	RANOGA PARK	STATE: CA	ZIP CODE:	91303
CAPACITY:	8	CENSUS: 6	DATE:	10/08/2021
		UNANNOUNCED	TIME BEGAN:	11:21 AM
MET WITH:	Larysa Shevchuk/Licensee		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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1) License: Overcapacity
2) Other: Uncleared adults working in facility
3) Physical Plant: Home looks dirty

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Silva Garibyan conducted a visit to the facility for the purpose of delivering the findings on the above allegations.

Based upon the evidence obtained through the course of investigation which include observations at the facility, interview with relevant parties there is insufficient evidence to support or disprove that facility is operating overcapacity, uncleared adults working in the faciliy, and the facility is dirty. Therefore, these allegations have been determined 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 and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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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