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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435700321
Report Date: 11/07/2023
Date Signed: 11/07/2023 11:14:00 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/01/2023 and conducted by Evaluator Morgan Pringle
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20231101130149
FACILITY NAME:MISHYNA, HULIZARFACILITY NUMBER:
435700321
ADMINISTRATOR:MISHYNA, HULIZARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 937-4543
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:14CENSUS: 11DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Hulizar MishynaTIME COMPLETED:
11:13 AM
ALLEGATION(S):
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Ratio - Licensee was operating out of ratio
INVESTIGATION FINDINGS:
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On 11/7/2023 Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Huilzar Mishyna for a complaint that was received alleging the facility was out of ratio. Present during the visit was the Licensee, her three (3) helpers, Yagana Aliyeva, Tatsiana Hancharyk and Leniie Useinova. There were also two (2) infants and nine (9) preschool age children present. Licensee's husband, Oleksandr Mishyn and infant son, 2 months old, were present as well but left shortly after LPA's arrival.

On 11/1/2023 Licensee and her three (3) helpers were operating with twelve (12) preschool age children in care with her infant son present in the home making her out of ratio with thirteen (13) children in care. Licensee immediatly contacted LPA Pringle to discuss a plan of action to correct being out of ratio.

During LPA's inspection today, Licensee has presented a plan of action that will ensure she stays within ratio at all times.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
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 52-CC-20231101130149
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MISHYNA, HULIZAR
FACILITY NUMBER: 435700321
VISIT DATE: 11/07/2023
NARRATIVE
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LPA determined the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D. Failure to submit Proof of Corrections (POC) by Plan of Correction date may result in civil penalties.

Exit interview conducted and report was reviewed with Licensee Hulizar Mishyna.



A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 52-CC-20231101130149
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MISHYNA, HULIZAR
FACILITY NUMBER: 435700321
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/09/2023
Section Cited
CCR
102416.5(d)(1)
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102416.5(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home...shall be either: (1) Twelve children, no more than four of whom may be infants; or...
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Licensee has enrolled her infant son in a childcare facility outside of the home. Licensee has stated her son will remain in care until a space is open in her home. Licensee will submit a written statement to LPA Pringle of the plan of action for remaining in compliance regarding ratios.
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This requirement was not met as evidenced by, on 11/1/2023 Licensee was found to be out of ratio with 12 preschool age children and her infant son present in the home. This poses a potential risk to the health and safety to the children in care.
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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: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3