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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494766
Report Date: 12/08/2022
Date Signed: 06/29/2023 11:11:56 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/15/2022 and conducted by Evaluator Suzette Ornelas
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20220915095912
FACILITY NAME:APPLE SCHOOL EARLY CHILDHOOD EDUCATIONAL CENTERFACILITY NUMBER:
197494766
ADMINISTRATOR:YELENA DOBRYNINAFACILITY TYPE:
850
ADDRESS:14123 VICTORY BLVDTELEPHONE:
(323) 449-1378
CITY:VAN NUYSSTATE: CAZIP CODE:
91401
CAPACITY:60CENSUS: 39DATE:
12/08/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Yelena Dobrynina - DirectorTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Record Keeping - Staff is disclosing confidential information
INVESTIGATION FINDINGS:
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On 12/08/2022 at 1:30pm, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced visit for the purpose of delivering the findings for the above-mentioned allegations. LPA Ornelas met with YELENA DOBRYNINA, Director. LPA toured the facility and observed 39 children in care being supervised by 11 staff.

During the course of the investigation, LPA Ornelas conducted parent interviews, obtained a copy of the children’s roster and reviewed documents in regard to the above allegation.

Information provided by the reporting party indicates that birthdays and last names have been shared among parents. When interviewing parents #3, #4, #6, #8, and #9, confirmed that full names and birthdays were being shared among parents; however, stated they did not have any concerns with the information being shared.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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 58-CC-20220915095912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: APPLE SCHOOL EARLY CHILDHOOD EDUCATIONAL CENTER
FACILITY NUMBER: 197494766
VISIT DATE: 12/08/2022
NARRATIVE
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Based on the information obtained throughout the course of the investigation, birthdays and last names have been shared among parents. The parents are aware and have given verbal consent to the facility for this to occur. The communication in which this information is being distributed is to the group of parents who have consented.

The allegations that Staff is disclosing confidential information is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation occurred.

An exit interview was conducted, and a copy of this report, appeal rights along with the Notice of Site Visit were provided to Director Yelena Dobrynina.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 58-CC-20220915095912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: APPLE SCHOOL EARLY CHILDHOOD EDUCATIONAL CENTER
FACILITY NUMBER: 197494766
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
12/08/2022
Section Cited
CCR
101221(c)(1)
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Record Keeping (c) All information and records obtained from or regarding children shall be confidential. (1) The licensee shall be responsible for safeguarding the confidentiality of record contents. This requirement is not met as evidenced by:

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Director did not agree to comply with a POC at this time. LPA will suggest Director come up with a plan to ensure that childrens last names and birthdays are kept confidential when sharing information with parents. DIrector will then provide LPA with a sample of how the information will look when being shared with parents.
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Based on documents obtained and interviews conducted, Director did not ensure children’s records remained confidential. This poses a potential risk to the health and safety of children in care.
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POC due date 12/31/2022
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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: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3