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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343622055
Report Date: 07/19/2022
Date Signed: 07/19/2022 12:24:45 PM

Substantiated


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
05/26/2022 and conducted by Evaluator Lea Habtom
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220526145927
FACILITY NAME:BOYKO, NATALIA & BARANOVA, TAMARAFACILITY NUMBER:
343622055
ADMINISTRATOR:BOKYO, N. & BARANOVA, T.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 470-6898
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:14CENSUS: 13DATE:
07/19/2022
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Natalia BoykoTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Day care child was taken to another facility without responsible party's permission.
INVESTIGATION FINDINGS:
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On July 19, 2022 Licensing Program Analysts Lea Habtom and Jeremey McClain met with licensee Natalia Boyko for the purpose of an unannounced visit to deliver the findings for the above allegations. During today’s visit there was a census of 13 children being supervised by 3 staff.

Day care child was taken to another facility without responsible party's permission.

During the investigation, LPA Habtom toured the facility, conducted observation and interviewed those pertinent to the investigation. It was alleged that a day care child was taken to another facility without the responsible party’s permission. Based on observation, LPA noticed that child #1 was present at the day care home but had licensing forms completed for another day care home. Further observation determined that licensing forms for other children who were on the facility roster and attended care at this day care home were completed with different day care home names. Based on sufficient evidence gathered, LPA Habtom was able to determine that the allegation day care child was taken to another facility to be SUBSTANTIATED meaning that the preponderance of evidence standard has been met.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022
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-20220526145927
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: 07/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2022
Section Cited
CCR
102352(f)(1)
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102352(f)(1)"Family Day Care" or "Family Child Care" means regularly provided care, protection and supervision of children, in the care giver's own home...

This requirement was not met as evidenced by:
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Licensee agreed to have paper work completed for all enrolled children with her facility name. Licensee is aware that children may not be moved from one day care facility to another.
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Observation that child #1 was in care with licensing forms assigned to another day care home. Further review of paper work showed that licensing forms had other day care names listed which causes a potential risk to the children in care.
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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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2