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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624087
Report Date: 10/09/2023
Date Signed: 10/09/2023 01:44:52 PM

Unsubstantiated


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
10/03/2023 and conducted by Evaluator Jennifer Velasco
COMPLAINT CONTROL NUMBER: 03-CC-20231003125245
FACILITY NAME:MIKHALCHUK, VERA, & MIKHALCHUK, YEVGENIYFACILITY NUMBER:
343624087
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
10/09/2023
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Vera MikhalchukTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is not following safe sleep practices
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Jennifer Velasco (LPA) conducted unannounced initial complaint investigation inspection and met with Licensee Vera Mikhalchuk (L1). LPA toured the facility, including all on-limits areas of the home. L1 was reminded never to exceed the conditions, limitations, and capacity specified on the license. Facility hours of operation are Monday through Friday from 7:00 AM to 5:30 PM.
It was alleged Licensee is not following safe sleep practices. During today's inspection, LPA conducted interviews, observed care provided to children, and obtained relevant documentation.
Witness statements, LPA observation, and facility documentation failed to corroborate the allegation. The preponderance of evidence standard has not been met; therefore, the allegation is unsubstantiated. An exit interview was conducted. This report was reviewed with and provided to Licensee. Appeal rights were provided to Licensee. A notice of site visit was posted and must remain posted where parents can see it for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023
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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