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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343618406
Report Date: 04/16/2021
Date Signed: 04/16/2021 02:19:08 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
01/08/2021 and conducted by Evaluator Jan Hoshida
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210108105556
FACILITY NAME:YUSHCHUK, TATYANAFACILITY NUMBER:
343618406
ADMINISTRATOR:YUSHCHUK, TATYANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 248-9499
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:14CENSUS: 7DATE:
04/16/2021
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tatyana YushchukTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Personal Rights: Inappropriate interactions occurred with a child.
INVESTIGATION FINDINGS:
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On 4/16/2021 at 1:00pm, due to the COVID-19 pandemic, Licensing Program Analyst (LPA), Jan Hoshida, conducted a tele-inspection via FaceTime and met with Licensee, Tatyana Yushchuk, to deliver findings and conclude the complaint investigation of the above allegation. There were 7 day care children present with Licensee and Licensee’s Assistant.

It was alleged that there were inappropriate interactions that occurred with a child. During the investigation, LPA conducted observations and gathered documents pertaining to the investigation. Further investigation was conducted by Investigator, Sonia Boyal, who conducted interviews with pertinent parties. The information received did not corroborate the allegation and there were discrepancies and inconsistences of the information obtained.

REPORT CONTINUED ON NEXT PAGE
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
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 03-CC-20210108105556
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: YUSHCHUK, TATYANA
FACILITY NUMBER: 343618406
VISIT DATE: 04/16/2021
NARRATIVE
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Based on the investigation conducted, although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. As a result, the allegations are UNSUBSTANTIATED.

An exit interview was conducted and Notice of Site Visit was provided to be posted for 30 days.

Facility evaluation report was emailed to Licensee and an email verification of receipt of report will be used in lieu of a signature on this report.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2