430701361-1-18-2022-07-CC-DSTN-CAZQAY-20220125110041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430701361
Report Date: 01/18/2022
Date Signed: 01/18/2022 11:27:29 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
10/28/2021 and conducted by Evaluator Ofelia Calivo

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20211028115105

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: 111	DATE:	01/18/2022
		UNANNOUNCED	TIME BEGAN:	10:38 AM
MET WITH:	Jill Miller		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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9

Staff do not treat children with dignity.

Facility is not reporting incidents to CCLD.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ofelia Calivo conducted an unannounced follow-up complaint investigation and met with Director Jill Miller. The purpose of today's follow-up complaint investigation is to deliver investigation findings.

The investigation of the allegations listed above was conducted by LPA Calivo. Based on observations and interviews completed for this complaint investigation, it is concluded that although the allegations noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED.

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

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022

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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