430700961-6-2-2022-07-CC-JSEA-CHBTDF-20220815143815

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430700961
Report Date: 06/02/2022
Date Signed: 06/02/2022 01:48:50 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
05/24/2022 and conducted by Evaluator Pietro Hernandez

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20220524155442

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: 55	DATE:	06/02/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Sarah Holloway		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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1) Daycare children were handled in a rough manner.

INVESTIGATION FINDINGS:

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On 6/2/2022: Licensing Program Analyst (LPA) Pietro Hernandez conducted an unannounced Subsequent Complaint Investigation at the Facility. LPA spoke with Director Sarah Holloway and discussed the finding for the above allegation.

During the course of the investigation, LPA inspected the Child Care Center, reviewed records, and conducted interviewed Teacher, and Parents. LPA Hernandez determined that the allegation is substantiated.

Continued on page 2 of LIC9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

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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Control Number 07-CC-20220524155442

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: 06/02/2022

NARRATIVE

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Continuation of Page 1 LIC9099
Allegation:

1) Daycare children were handled in a rough manner. .

LPA Hernandez interviewed 5 staff and 4 staff confirmed that the The 1 staff had acted inappropriately. The line of questioning was initiated by the RPs statement. Relevant decision making information was provided by the the investigation. LPA was able to confirm that the terminated staff did act out in an aggressive manner to the children in care. Although none of the children were physically injured they were handled in a rough manner: LPA confirmed that the terminated Staff's aggressive behavior involved added up to inappropriate and aggressive behavior towards the children in her care.

The Director dismissed the Teacher as a result of what had occurred on 5/24/2022. I

The Allegation is being 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 LIC809D. An exit interview was conducted, and Plan of Corrections were reviewed and developed with the Licensee. A copy of this report and appeals rights were discussed and left with the Licensee, Sarah Holloway, whose signature on this form confirm receipt of these documents.

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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC9099 (FAS) - (06/04)

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Control Number 07-CC-20220524155442

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: 06/02/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/03/2022 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	Personal Rights 101223 (a)(3): The licensee shall ensure that each child is accorded the following personal rights:(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping [...] This requirement is not met as evidenced by:	1 2 3 4 5 6 7	BY POC DUE DATE 6/3/2022, Director agreed to ensure that the plan of operation is thoroughly followed regarding Personal Rights of children in care and that all the staff will be trained on Personal Rights.Director will send a copy of the documentation to Licensing.
	8 9 10 11 12 13 14	LPA's investigation verified that staff 1 admitted to the allegation. Specifically, she restrained one of the children in care and acted in an aggressive manner to several children. This poses a potential risk to the children in care.	8 9 10 11 12 13 14
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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: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC9099 (FAS) - (06/04)

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