343617934-2-16-2021-03-CC-RSAA-BYDM72-20210219082046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343617934
Report Date: 02/08/2021
Date Signed: 02/16/2021 04:19:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/15/2020 and conducted by Evaluator Tanya Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20200715110936

FACILITY NAME:	LOBKOV, VERA		FACILITY NUMBER:	343617934
ADMINISTRATOR:	LOBKOV, VERA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 799-9532
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	14	CENSUS: 4	DATE:	02/08/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Vera Lobkov		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Personal Rights- Child sustained bruising to both ears while in child-care

INVESTIGATION FINDINGS:

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On Monday, February 8, 2021 approximately at 12:45 PM. Licensing Program Analyst Tanya Washington contacted Licensee Vera Lobkov to deliver complaint finding for the allegation of children’s personal rights. The complaint is being delivered via Facetime due to COVID-19 pandemic.
The Reporting Party alleged that Child #1, sustained unexplained injuries while in care.
Investigator Andrew Murrow from The Department’s Investigations Branch conducted the investigation. During the course of the investigation Mr. Murrow conducted interviews with Child Abuse Doctor, parent of Child #1, Licensee, daycare children, a parent of currently enrolled child and a parent of child who no longer attends the facility. Investigator also reviewed childcare records, medical record for Child #1 and consulted with Law Enforcement.
Continued on LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021

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 03-CC-20200715110936

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LOBKOV, VERA	FACILITY NUMBER: 343617934
	VISIT DATE: 02/08/2021

NARRATIVE

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During the interview conducted by Investigator Murrow, Licensee stated that she did not witness Child #1 get injured and denied hitting Child #1. Licensee provided multiple reasons of how Child #1 could have possibly been injured but based on Child Abuse Doctor’s opinion bruising on the ears is rarely accidental. Based on the opinion of Child Abuse Doctor and Licensee not being able to provide an accurate account of how Child #1 sustained their injury the allegation of personal rights is substantiated. The Child Abuse Doctor stated that the injury was inflicted by an adult and could not have been self-inflicted.

Based upon evidence obtained, there is a preponderance of evidence to support the allegation; therefore, the finding is SUBSTANTIATED.

Title 22 deficiency is cited on the subsequent page of this report (LIC809D). Licensee acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, Licensee shall post LIC9099-D with Type A deficiency for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Licensee. This report was reviewed with the Licensee. Report, appeal rights, LIC9224, and notice of site visit will be delivered electronically to Licensee via email. Acknowledgement of receipt of reports will be documented in lieu of signature.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 03-CC-20200715110936

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LOBKOV, VERA	FACILITY NUMBER: 343617934
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/08/2021 Section Cited CCR 102423(4)	1 2 3 4 5 6 7	(4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature...	1 2 3 4 5 6 7	Licensee stated that she disagrees with the finding and stated that parent of Child #1 regularly looked over the child upon pick up and did not see or mention any injuries until they left.
	8 9 10 11 12 13 14	This requirement is not met as evidenced: Child #1 sustained bruising to both ears while in care. Licensee could not explain how the injury occurred. This is a violation of child’s personal rights.	8 9 10 11 12 13 14	Licensee stated that she communicates with parents immediately if any issues arise while their child is in care and have not had any issues with parent of Child #1 while they attended.
	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: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021

LIC9099 (FAS) - (06/04)

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