343623767-8-5-2021-03-CC-KPES-C5ZKVY-20210818081504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343623767
Report Date: 08/05/2021
Date Signed: 08/05/2021 09:43:21 AM

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
07/15/2021 and conducted by Evaluator Tanya Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20210715104142

FACILITY NAME:	PARKER, MARK AND BURAKOVSKA, LIUDMYLA		FACILITY NUMBER:	343623767
ADMINISTRATOR:	PARKER, MARK BURAKOVSKA,L		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(219) 384-1228
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	14	CENSUS: 9	DATE:	08/05/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Liudmyla Burakovska		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Licensee does not live in the home

INVESTIGATION FINDINGS:

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On August 5, 2021 at 9:00 AM, Licensing Program Analysts (LPAs) Tanya Washington and Jeremey McClain met with Licensee Liudmyla Burakovska to deliver complaint findings for the allegation of Licensee not living in the home. During today’s inspection LPAs observed care and supervision of 9 children supervised by Licensee Liudmyla Burakovska and Staff #1.

During the course of the investigation LPA Washington conducted interviews with both Licensees, staff, children in care and some neighbors. Licensee Burakovska gave a tour of the entire home and showed where her room is located and where Mark Parker’s room is located. LPAs observed clothing and personal items belonging to both Licensees.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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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Control Number 03-CC-20210715104142

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: PARKER, MARK AND BURAKOVSKA, LIUDMYLA	FACILITY NUMBER: 343623767
	VISIT DATE: 08/05/2021

NARRATIVE

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Some interviews revealed that Mark Parker lives in this home and comes to this facility to work and also has another place of residence.
Based on documents review pertaining to the allegation, observations and interviews LPA Washington determined that Licensee Burakovska resides in the home. LPA received conflicting information regarding the residence of Licensee Parker, furthermore LPA received an application on 08/02/2021 requesting to remove co-licensee Mark Parker from the license.

LPAs determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the Licensees do not live in the home; therefore, the allegation is determined to be unsubstantiated.

Exit interview was conducted. Appeal rights provided. Notice of site visit posted.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC9099 (FAS) - (06/04)

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