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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416382
Report Date: 04/24/2023
Date Signed: 04/24/2023 03:35:46 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2022 and conducted by Evaluator Marilou Monico
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20221003105102
FACILITY NAME:SKVORTCOVA, ELENAFACILITY NUMBER:
434416382
ADMINISTRATOR:SKVORTCOVA, ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 667-2985
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:14CENSUS: 2DATE:
04/24/2023
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Elena SkvortcovaTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Provider's conduct poses a risk to day care children.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs), Marilou Monico, and Ashley Lopez, made an unannounced follow-up complaint inspection to deliver investigation findings. LPAs met with provider, Elena Skvortcova. Based on police reports and other evidence obtained during the investigation process, the preponderance of
evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiency was cited on the following page:

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023
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 2
Control Number 07-CC-20221003105102
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SKVORTCOVA, ELENA
FACILITY NUMBER: 434416382
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/25/2023
Section Cited
CCR
102423(a)(2)
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Personal Rights - Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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Elena Skvortcova's license to operate a family child care license has been revoked effective 02/24/23.
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The above requirement is not met as evidenced by: Provider's conduct poses a risk to day care children. This poses an immediate risk to the health, safety, and personal rights, of 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: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2