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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004743
Report Date: 03/22/2024
Date Signed: 03/22/2024 09:34:38 AM

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
01/19/2024 and conducted by Evaluator Jonathan Tse
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240119103540
FACILITY NAME:LOZINSCAIA, TATIANAFACILITY NUMBER:
414004743
ADMINISTRATOR:LOZINSCAIA, TATIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 686-9700
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:14CENSUS: 7DATE:
03/22/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee, Tatiana LozinscaiaTIME COMPLETED:
09:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Provider does not reside in the home
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/22/2024, at approximately 8:30AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced complaint investigation visit. LPA was granted entry to the facility by Licensee, Tatiana Lozinscaia (L1). Present during the visit was L1, a helper (H1), H1's minor daughter, two infants and five preschool age children.
During the course of the investigation, LPA conducted record review, site observations, and staff interviews. The provider denied the allegations. LPA observed the provider to be present upon entry to the facility. Based on interviews with relevant parties, review of relevant documentation, and LPA's observations, there is no direct evidence to prove that the allegation above did or did not occur.
Based on relevant information reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.
Appeal rights were provided to Licensee. A Notice of Site Visit was provided and must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview was conducted and report was reviewed with Licensee, Tatiana Lozinscaia.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
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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