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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414005046
Report Date: 11/15/2024
Date Signed: 11/15/2024 03:30:12 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
09/18/2024 and conducted by Evaluator Melissa Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240918112649
FACILITY NAME:POBEREZHNA, ALINAFACILITY NUMBER:
414005046
ADMINISTRATOR:POBEREZHNA, ALINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 308-6511
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:14CENSUS: 6DATE:
11/15/2024
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Licensee, Alina PoberezhnaTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee yelled at child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 15, 2024, at approximately 2:40PM. Licensing Program Analysts (LPA) Melissa Zaragoza conducted an unannounced, complaint visit to deliver the findings. LPA met with license, Alina Poberezhna, and the purpose of the visit was explained. Present in the facility today was the licensee, one staff, and 6 children.

During investigation, LPA conducted research, reviewed facility records, interviews, and walk through observation inspections of the home. LPA observed the childcare program while operating. LPA reminded the licensee about childcare regulations, and how to maintain a safe environment for the children in care.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted and report was reviewed with licensee, Alina Poberezhna. A copy of this report was provided.

Notice of site visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
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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