<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343625451
Report Date: 04/08/2024
Date Signed: 04/08/2024 03:54:32 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/29/2024 and conducted by Evaluator Erwina Pascual-Golamco
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240329151430
FACILITY NAME:KONTSEMAL, ANASTASIIAFACILITY NUMBER:
343625451
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
04/08/2024
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Anastasiia KontsemalTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is operating out of ratio
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Erwina Pascual-Golamco and Loraine Perez (LPA) met with Licensee Anastasiia Kontsemal for the purpose of opening and closing a complaint investigation of the above allegation. The purpose of today's inspection was explained.

It was alleged that facility is operating out of ratio. Throughout the course of investigation, LPA conducted observations, reviewed records, documentation, and conducted interview. It was determined by interview with Licensee that the facility was operating out of ratio on 3/28/24, Licensee stated she had 8 children in care, none were enrolled in and attending kindergarten or elementary school and is at least six years of age.

Based on LPA interview, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.
Continued on LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
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 3
Control Number 03-CC-20240329151430
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KONTSEMAL, ANASTASIIA
FACILITY NUMBER: 343625451
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/09/2024
Section Cited
CCR
102416.5(b)(3)(a)
1
2
3
4
5
6
7
102416.5 Staffing Ratio and Capacity (b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time...(3)more than six and up to eight children...if all of the following conditions are met:(a)At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.
1
2
3
4
5
6
7
Licensee stated she will comply with small family child care ratios moving forward, and will document attendance daily on a separate notebook for documentation. LPA will conduct a Plan of Correction visit.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: on 3/28/24, Licensee stated she had 8 children in care, none were enrolled in and attending kindergarten or elementary school and is at least six years of age, which poses an immediate 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.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20240329151430
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KONTSEMAL, ANASTASIIA
FACILITY NUMBER: 343625451
VISIT DATE: 04/08/2024
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
Licensee was informed that this report dated 04/08/24 documents one Type A citation . A Title 22 Deficiency is issued on the attached LIC9099-D page. Licensee shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. Exit interview was conducted with Licensee, appeal rights were provided, and A notice of site visit was given to Licensee, who will post it where visible to parents/guardians for 30 days. A signed Acknowledgement of Receipt of the Licensing Report (LIC 9224) must be placed in the child's file for verification.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3