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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 354415286
Report Date: 07/10/2023
Date Signed: 07/10/2023 10:52:01 AM

Unsubstantiated


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
02/10/2023 and conducted by Evaluator Deanna Villagrana
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230210145724
FACILITY NAME:ROBISON, ITSARIYABHORNFACILITY NUMBER:
354415286
ADMINISTRATOR:ROBISON, ITSARIYABHORNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 524-2288
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:14CENSUS: 12DATE:
07/10/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Itsariyabhorn RobisonTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
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9
Reporting Requirements
INVESTIGATION FINDINGS:
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2
3
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Licensing Program Analysts (LPAs) Deanna Villagrana and Susy Cervantes met with licensee Itsariyabhorn Robison to deliver findings for above allegation. Present were licensee, licensee's mom who is her assistant and 12 day care children including two infants and licensee's two sons.

Based on interviews and pertinent documentation obtained, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiency was cited.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023
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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