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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414002194
Report Date: 10/30/2023
Date Signed: 10/30/2023 04:01:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/06/2023 and conducted by Evaluator Catrina Quimbo
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230906112546
FACILITY NAME:TSYURA, IRINAFACILITY NUMBER:
414002194
ADMINISTRATOR:TSYURA, IRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 722-5458
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:14CENSUS: 7DATE:
10/30/2023
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Irina TsyuraTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
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5
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7
8
9
Staff hit child in care.
INVESTIGATION FINDINGS:
1
2
3
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5
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7
8
9
10
11
12
13
On October 30, 2023 at approximately 3:45pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, complaint visit. LPA met with licensee, Irina Tsyura, and explained the purpose of the visit.

Present during LPA’s visit included licensee, licensee’s 2 assistants, and 7 preschool children. Licensee is operating within capacity limits and ratio during LPA’s visit. All adults present have fingerprint clearance on file.

During investigation, LPA interviewed random selection of staff, random selection of children, and reviewed facility records. Staff interviewed stated staff do not put their hands on children. Staff interviewed also stated children with challenging behavior are redirected. Children interviewed stated they have not been hit by staff nor children while present in licensee’s home. Per licensee’s admission agreement, children with difficult behavior are redirected.

Although the above allegation may have happened or is valid, based on LPA’s interviews and record review which were conducted, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee, Irina Tsyura.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
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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