343622055-7-14-2021-03-CC-KPES-C4YN66-20210716101036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343622055
Report Date: 07/14/2021
Date Signed: 07/14/2021 12:01:32 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
04/19/2021 and conducted by Evaluator Rosie Pitts

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20210419145725

FACILITY NAME:	BOYKO, NATALIA & BARANOVA, TAMARA		FACILITY NUMBER:	343622055
ADMINISTRATOR:	BOKYO, N. & BARANOVA, T.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 470-6898
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	14	CENSUS: 12	DATE:	07/14/2021
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Natalia Boyko		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Other:Licensee is not residing in the home

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosie Pitts met with Co- Licensee Natalia Boyko for the purpose of closing the complaint allegation mentioned above. LPA observed 12 children being supervised by 4 Staff.
Throughout the investigation, LPA toured the home, conducted observations, interviews and obtained documents relevant to the complaint allegation. During a tour of the home, LPA observed that Co- Licensee Tamara had no clothes or personal belongings in the bedroom that she stated was hers. Co-Licensee Tamara stated that she does spend the night in the home, but also resides in a different home where her belongings are.
Co-Licensee Boyko stated that Co-Licensee Tamara has moved from her other home and moved all of her belongings to their facility on approximately July 3rd, 2021.
Based on observations, interviews conducted, and information obtained, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED
Report continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: 916-862-1086
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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 5

Control Number 03-CC-20210419145725

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: BOYKO, NATALIA & BARANOVA, TAMARA	FACILITY NUMBER: 343622055
	VISIT DATE: 07/14/2021

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Title 22 deficiencies were cited and must be corrected by the due date. Appeals rights were discussed and issued. An exit interview was conducted in which the report was reviewed and discussed with licensee. Upon receipt of this report, the report must be posted for 30 days for parents to view.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: 916-862-1086
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 03-CC-20210419145725

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: BOYKO, NATALIA & BARANOVA, TAMARA	FACILITY NUMBER: 343622055
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/14/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/26/2021 Section Cited CCR 1596.78	1 2 3 4 5 6 7	"Family day care home" means a home that regularly provides care, protection, and supervision for 14 or fewer children, in the provider's own home...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee Boyko stated that Co-Licesnee Tamara has moved out of her other residence and has moved her things to their Day-care facility. A statement from Co-Licensee Tamara in writing and additional proof of residency is to be provided
	8 9 10 11 12 13 14	Based on observations and interviews LPA obtained information that supports the allegation that Licensee does not live in the home., which poses a potential health and safety risk to children 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: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: 916-862-1086
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 5

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
04/19/2021 and conducted by Evaluator Rosie Pitts

COMPLAINT CONTROL NUMBER: 03-CC-20210419145725

FACILITY NAME:	BOYKO, NATALIA & BARANOVA, TAMARA		FACILITY NUMBER:	343622055
ADMINISTRATOR:	BOKYO, N. & BARANOVA, T.		FACILITY TYPE:	810
ADDRESS:	3909 NEW YORK AVENUE		TELEPHONE:	(916) 470-6898
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	14	CENSUS: 12	DATE:	07/14/2021
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Natalia Boyko		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Licensee is operating beyond her licensed capacity.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosie Pitts met with Co Licensee Boyko for the purpose of closing the complaint allegation mentioned above. LPA observed 12 children being supervised by 4 Staff. Throughout the investigation, LPA toured the home, conducted observations, interviews and obtained documents relevant to the complaint allegation.
Co- Licensee Boyko stated that she never has more than 14 children in care at one time. s
Based on the facility roster, LPA determined there are currently 16 children enrolled and Co-Licensee Boyko stated that not every child comes everyday. During both of LPA's visits, the facility was operating within capacity. LPA was unable to determine if the facility has operated beyond the License limitations.

Report continued on 9099A-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: 916-862-1086
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 03-CC-20210419145725

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: BOYKO, NATALIA & BARANOVA, TAMARA	FACILITY NUMBER: 343622055
	VISIT DATE: 07/14/2021

NARRATIVE

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Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur at the facility; therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted and a Notice of Site Visit was posted. Due to conflicting information, the above allegation is UNSUBSTANTIATED. Although the allegation may be valid, there is not a preponderance of evidence to prove or disprove. An exit interview was conducted and a Notice of Site Visit was posted.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: 916-862-1086
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 5