430700549-6-15-2021-07-CC-SKNT-C42S7Z-20210616133818

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430700549
Report Date: 06/14/2021
Date Signed: 06/15/2021 09:21:04 AM

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
03/03/2021 and conducted by Evaluator Anna Morales

COMPLAINT CONTROL NUMBER: 07-CC-20210303104502

FACILITY NAME:	SAN JOSE DAY NURSERY		FACILITY NUMBER:	430700549
ADMINISTRATOR:	ELENA JOLLY		FACILITY TYPE:	850
ADDRESS:	33 NORTH 8TH STREET		TELEPHONE:	(408) 288-9667
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	88	CENSUS: 74	DATE:	06/14/2021
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Shannon Allard		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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1. Day care child was restrained while in care
2. Staff did not ensure child was properly dressed.
3. Staff inappropriately touched day care child.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA's)Anna Morales and Pete Hernandez conducted a Subsequent visit to deliver the findings for the above allegations. LPA's were greeted by Center Director Shannon Allard.

The complaint investigation was conducted by Investigator Cari Farquhar. Based on the supporting information obtained by Investigator Farquhar the following allegations, Day care child was restrained while in care, Staff did not ensure child was properly dressed,Staff inappropriately touched day care child, may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore, the allegation is found to be UNSUBSTANTIATED.

Exit interview conducted and copy of this report provided to the Director.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

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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