430701361-7-10-2019-07-CC-ASTR-BFP892-20190903221823

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430701361
Report Date: 07/10/2019
Date Signed: 07/10/2019 02:07:11 PM

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
06/04/2019 and conducted by Evaluator Zaid Hakim

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20190604133952

FACILITY NAME:	ACTION DAY NURSERY		FACILITY NUMBER:	430701361
ADMINISTRATOR:	JILL MILLER		FACILITY TYPE:	850
ADDRESS:	2146 LINCOLN AVENUE		TELEPHONE:	(408) 266-8952
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	154	CENSUS: 150	DATE:	07/10/2019
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Jill Miller		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility failed to keep facility free from pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zaid Hakim conducted an Unannounced Subsequent Complaint Investigation at the facility today. Upon arrival, LPA observed 150 preschool age children and at least 22 staff engaging in daily activities and met with Ms. Jill Miller, Director. LPA conducted subsequent record reviews, facility observations, and staff interviews.

During the course of the investigation, LPA conducted physical plant inspections, reviewed facility records and documentation, and conducted staff interviews. LPA learned that the facility did have a documented pest or insect presence, which was addressed by the Director through a third party cleaning company. Although the Director addressed this issue promptly, the facility did not adequately safeguard against the presence of pests or insects which were present in the facility.

Based on the information obtained throughout the investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

A Deficiency has been cited as a result of this complaint investigation. Refer to page 9099-D for citation, description, and plan of correction. Appeal rights have been provided and discussed. A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid Hakim	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

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-20190604133952

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	FACILITY NUMBER: 430701361
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/17/2019 Section Cited CCR 101238(a)(1)	1 2 3 4 5 6 7	Buildings and Grounds The licensee shall take measures to keep the center free of flies, other insects, and rodents.	1 2 3 4 5 6 7	The Director promptly responded to this issue at the time of occurrence. To be completed by the end of the day by the POC due date, Director has agreed
	8 9 10 11 12 13 14	Evidenced by direct observations and a documented work order to address the presence of pests or insects in the facility. This presents a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14	to submit a written plan outlining how the facility will be proactive in safeguarding against pests or insects and ensuring the facility is clean, safe and sanitary at all times.
	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: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid Hakim	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC9099 (FAS) - (06/04)

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