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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198004154
Report Date: 11/13/2020
Date Signed: 11/13/2020 02:40:22 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/24/2020 and conducted by Evaluator Crystal Green
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20200324142539
FACILITY NAME:WOODBURY VILLAGE, INC.-INFANT CENTERFACILITY NUMBER:
198004154
ADMINISTRATOR:DANIELLE SVIHOVEC-MESQUITAFACILITY TYPE:
830
ADDRESS:712 W. MT. VIEW ST.TELEPHONE:
(626) 794-3211
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:41CENSUS: 15DATE:
11/13/2020
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Michelle Svihovec TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff is not following safety standards for cleaning at the facility.
Staff are not washing their hands.
Staff are not ensuring that children wash their hands and are kept clean.
Staff are not sending sick children home.
INVESTIGATION FINDINGS:
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An unannounced site visit was conducted by Licensing Program Analyst (LPA) Crystal Green and Nolan Tcheng. The purpose of the site visit is to deliver findings for the above complaint allegations. Due to COVID- 19 precautionary measures were taken, individuals present during inspection wore appropriate personal protective equipment.

Upon arrival licensing staff met with Administrator, Michelle Svihovec. The facility is currently operating and a total of 15 children were present. During the course of this investigation, Licensing staff conducted interviews with several staff members, licensee, and reporting party. Based on the information obtained from the interviews, at this time there is not enough evidence to support the above allegations. Therefore, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, the above allegations are deemed unsubstantiated. No citation is being issued during today’s inspection.

*Report continues on the next page*
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 854-5730
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2020
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 33-CC-20200324142539
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WOODBURY VILLAGE, INC.-INFANT CENTER
FACILITY NUMBER: 198004154
VISIT DATE: 11/13/2020
NARRATIVE
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Exit interview was conducted with Licensee Danielle Svihovec- Mesquita . The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 854-5730
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2020
LIC9099 (FAS) - (06/04)
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