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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343618483
Report Date: 03/10/2022
Date Signed: 03/10/2022 12:11:54 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
01/14/2022 and conducted by Evaluator Kelly Ferrara
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220114161138
FACILITY NAME:GOLUB, INNAFACILITY NUMBER:
343618483
ADMINISTRATOR:GOLUB, INNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 844-5042
CITY:SACRAMENTOSTATE: CAZIP CODE:
95842
CAPACITY:14CENSUS: DATE:
03/10/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Inna GolubTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Day care provider did not meet day care child's hygiene needs.
Day care children were not adequately supervised.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Kelly Ferrara and Tanya Washington conducted a complaint follow up inspection to deliver findings and met with Licensee Inna Golub. LPAs observed there were currently seven children in care with Licensee and an assistant. During the investigation, LPA Ferrara interviewed Licensee and witnesses.

It was alleged that the children did not have proper hygiene while in the provider’s care. LPAs observed that children appeared clean during multiple inspections. Licensee stated that her routine is to clean the children including washing their hands and face and changing any diapers through out the day and before they leave for the day. It was alleged that the children were left in the care of a teenage child. LPA Ferrara observed the assistant was present at the initial inspection but was in a separate room from the children. Consistent statements were made during interviews that either the Licensee or an assistant is always present in the home along with their own teenage children. LPAs discussed 102417(a) regarding supervision.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
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-20220114161138
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: GOLUB, INNA
FACILITY NUMBER: 343618483
VISIT DATE: 03/10/2022
NARRATIVE
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Based on the evidence obtained, LPA determined that the allegations are unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove it. Exit interview was conducted and a copy of this report was given to the Licensee. Notice of Site was provided which must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2