430700961-5-14-2021-07-CC-SKNT-C34RE4-20210517125652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430700961
Report Date: 05/13/2021
Date Signed: 05/14/2021 10:49:12 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
04/30/2021 and conducted by Evaluator Pietro Hernandez

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20210430142846

FACILITY NAME:	ACTION DAY NURSERY ON PRUNERIDGE		FACILITY NUMBER:	430700961
ADMINISTRATOR:	SARAH HOLLOWAY		FACILITY TYPE:	850
ADDRESS:	2001 PRUNERIDGE AVENUE		TELEPHONE:	(408) 244-2909
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95050
CAPACITY:	68	CENSUS: 58	DATE:	05/13/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Sarah Holloway		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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1) Classroom is operating out of ratio.

INVESTIGATION FINDINGS:

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On 05/13/2021: Licensing Program Analyst (LPA) Pietro Hernandez conducted an unannounced Subsequent Complaint Investigation via Video Conference at the Facility. LPA spoke with Sarah Holloway and discussed the finding for the above allegations. This was also delivered by email return receipt to the Facility during the visit.

During the course of the investigation, LPA inspected the Child Care Center, reviewed records, and conducted interviews with the Director and Teachers. LPA Hernandez determined that the allegation is Substantiated.

Continued on page 2 of LIC9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

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 5

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
04/30/2021 and conducted by Evaluator Pietro Hernandez

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20210430142846

FACILITY NAME:	ACTION DAY NURSERY ON PRUNERIDGE		FACILITY NUMBER:	430700961
ADMINISTRATOR:	SARAH HOLLOWAY		FACILITY TYPE:	850
ADDRESS:	2001 PRUNERIDGE AVENUE		TELEPHONE:	(408) 244-2909
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95050
CAPACITY:	68	CENSUS: 58	DATE:	05/13/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Sarah Holloway		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
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3
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5
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8
9

2) Facility is not communicating incidents to parents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
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13

On 5/13/2021: Licensing Program Analyst (LPA) Pietro Hernandez conducted an unannounced Subsequent Complaint Investigation via Video Conference at the Facility. LPA spoke with Sarah Holloway and discussed the finding for the above allegations. This was also delivered by email return receipt to the Facility during the visit.

During the course of the investigation, LPA inspected the Child Care Center, reviewed records, and conducted interviews with the Director and Teachers. LPA Hernandez determined that the second allegation unsubstanciated.

Continued on page 2 of LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 07-CC-20210430142846

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: ACTION DAY NURSERY ON PRUNERIDGE	FACILITY NUMBER: 430700961
	VISIT DATE: 05/13/2021

NARRATIVE

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Continuation of Page 1 LIC9099

Allegation 2) Facility is not communicating incidents to parent.

LPA Hernandez Interviewed the Directors and Staff regarding the allegation in order to make a reasonable finding. LPA did not observe any dereliction of duty, lack of care for the children regarding the allegation, or any reason to think they could have known what they did not observe or was not reported to them by the children or unusual behavior. In two instances the children sustained minor injuries on separate occasions that were discovered by the parents away from the facility that the Teacher or any other staff could have observed and taken action otherwise..

Based on the interviews and information obtained throughout the investigation, the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A deficiency is not being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted by Video Conference, and Plan of Corrections was reviewed and developed with the licensee. A copy of this report and appeals rights were discussed and provided to the Licensee by email, Sarah Holloway, as proof this form has been confirmed received by "return receipt" of these documents due to Covid-19 shelter in place orders.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 07-CC-20210430142846

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: ACTION DAY NURSERY ON PRUNERIDGE	FACILITY NUMBER: 430700961
	VISIT DATE: 05/13/2021

NARRATIVE

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Continuation of Page 1 LIC9099

Classroom is operating out of ratio.

LPA Pete Hernandez conducted interviews of the Directors, Staff and reviewed documentation related to the allegation. LPA Hernandez discovered that the facility was operating out of ratio. LPA discovered that the this occurred on at least two separate occasions in the past month.

Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED.

A deficiency is being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC9099D. An exit interview was conducted by Video Conference, and Plan of Corrections was reviewed and developed with the licensee. A copy of this report and appeals rights were discussed and provided to the Licensee by email, Sarah Holloway, as proof this form has been confirmed received by "return receipt" of these documents due to Covid-19 shelter in place orders.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 07-CC-20210430142846

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: ACTION DAY NURSERY ON PRUNERIDGE	FACILITY NUMBER: 430700961
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/13/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/13/2021 Section Cited CCR 101216.3(a)	1 2 3 4 5 6 7	101216.3 (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	BY THE POC DATE 6/13/2021 the Licensee will submit a plan of correction to avoid exceeding ratio in the future.
	8 9 10 11 12 13 14	LPA observed one of the preschool classes operating out of ratio on at least two separate occasions in the past month. This was supported by documentation and investigative interviews. This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5