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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619113
Report Date: 03/06/2023
Date Signed: 03/10/2023 03:14:48 PM

Document Has Been Signed on 03/10/2023 03:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:MOKRUSHIN, NADIAFACILITY NUMBER:
343619113
ADMINISTRATOR:NADIA MOKRUSHINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 684-5382
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:23 PM
MET WITH:Mailed to Nadia MokrushinTIME COMPLETED:
03:24 PM
NARRATIVE
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On 02/9/2023, Licensing staff had scheduled a meeting with Licensee Nadia Mokrushin (L1) for the purpose of delivering the finding for a Case Management to address L1’s conduct exhibited during a complaint visit on 8/24/2022 conducted by LPA Maestas (LPA1) and LPA Williams (LPA2), but the meeting was cancelled.

On 8/24/2022, L1 informed LPA1 that her inactive status had expired and therefore offered L1 a new form to fill out to request an extension fof her inactive status. LPA1 attempted to explain that the Department had never received any written verification of her intent to extend her inactive status. L1 snatched the form from LPA1 and stated that she wanted to remain inactive indefinitely and had previously told her former LPA of her intent to remain inactive. LPA1 explained that the Department never received a written request to remain inactive and that she was attempting to verify the status of the license. LPA1 explained that the actual reason for the field visit was due to a complaint that the Department received and requested to enter the Family Child Care Home (FCCH) so they could have a discussion and leave a report. L1 refused to let the LPAs enter the FCCH and demanded to know who filed the complaint. L1 was shouting at the LPAs and using profanity while threatening to sue the Department. When asked, L1 refused to provide a Facility Roster. The LPAs wrote a complaint report from their vehicle and afterwards, returned to L1’s front door to provide L1 with the report. L1 took the report but refused to sign the report. L1, although inactive, is still a licensed Family Child Care Home and is expected to allow the Department to conduct an investigation. L1 made it unnecessarily difficult for the LPAs to do their job by being uncooperative and displaying behavior that was intimidating. Furthermore, Licensee has presented similar conduct towards multiple Licensing staff in 2019. Based on L1’s behavior towards the Department’s Licensing staff, L1 is being cited a Type-A deficiency for Conduct Inimical and impeding the Department’s investigation on a subsequent 809-D page. Two copies of this report have been mailed to L1 on 3/6/2023 due to multiple cancellations of an in-person meeting. Please sign one copy and return in pre-stamped envelope and keep one copy for your records. Included is a copy of the Appeal Rights.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 03/10/2023 03:14 PM - It Cannot Be Edited


Created By: Nola Maestas On 03/06/2023 at 03:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MOKRUSHIN, NADIA
FACILITY NUMBER: 343619113

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/06/2023
Section Cited
HSC
1596.885

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GROUNDS/CONDUCT INIMICAL: Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this State. This requirement was not met as evidenced by Licensee’s refusal to cooperate with the Department on
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Licensee agrees to treat licensing staff with respect moving forward.
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 08/24/2022 as exhibited by the Licensee’s use of profanity and inappropriate behavior towards the Department’s representatives/LPAs.
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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.
SUPERVISOR'S NAME:Jeanne Smith
LICENSING EVALUATOR NAME:Nola Maestas
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2023


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