343622895-7-26-2022-03-CC-RSAA-CGPV3B-20220726160427

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343622895
Report Date: 07/26/2022
Date Signed: 07/26/2022 02:59:38 PM

Unsubstantiated

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
05/02/2022 and conducted by Evaluator Michelle Pascual

COMPLAINT CONTROL NUMBER: 03-CC-20220502085544

FACILITY NAME:	BEREZENKO, IRINA		FACILITY NUMBER:	343622895
ADMINISTRATOR:	BEREZENKO, IRINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 752-9810
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY:	14	CENSUS: 6	DATE:	07/26/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Irina Berezenko		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Personal Rights- Child sustained a broken arm while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Michelle Pascual met with licensee Irina Berezenko, on July 26th, 2022 at approximately 1pm to deliver findings for the above allegation. Upon arrival LPA observed 6 children in care.

The complaint alleged that a child sustained a broken arm while in care. The Investigative Branch (IB) investigated the complaint through a series of interviews with medical staff, the licensee, childcare staff as well as interviews with Guardians of children in care. IB found that although a child did have a fractured arm there was not sufficient enough evidence to conclude the incident occurred while in care.

Based on the information gathered throughout the course of this investigation there was not sufficient enough evidence nor information to support or dismiss the above allegation. Therefore, the finding for the above allegation was determined to be UNSUBSTANTIATED. An exit interview was conducted in which the report was reviewed and discussed with the licensee
Appeal rights were discussed and a printed version was given to licensee.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022

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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