<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430701361
Report Date: 04/18/2024
Date Signed: 04/18/2024 02:14:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
04/12/2024 and conducted by Evaluator Mandeep Kaur
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240412125939
FACILITY NAME:ACTION DAY NURSERYFACILITY NUMBER:
430701361
ADMINISTRATOR:BATE, STEPHANIEFACILITY TYPE:
850
ADDRESS:2146 LINCOLN AVENUETELEPHONE:
(408) 266-8952
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:154CENSUS: 126DATE:
04/18/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Lucy Nunez and Smriti DattaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child wandered from the facility due to lack of staff supervision.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Mandeep Kaur conducted an unannounced complaint investigation. LPA met with Site Supervisor, Lucy Nunez and Site Director, Smriti Datta, and explained the complaint allegation to them. Complaint allegation is the same incident that LPA and Licensing program manager (LPM), Joel Segura addressed as a Case Management-incident inspection on 04/12/2024.

Site Supervisor stated that incident happened on 04/11/2024 around 5:15PM, where a child (C1) wandered away from their classroom. Site Director stated that a child (C1) left the classroom by themselves, following a parent. Site Director stated that a child (C1) was found in the preschool parking lot.

Based on interviews, a child (C1) Day care child wandered from the facility due to lack of staff supervision.
**Continue on Next Page**

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
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
SAN JOSE CC RO, 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
04/12/2024 and conducted by Evaluator Mandeep Kaur
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240412125939

FACILITY NAME:ACTION DAY NURSERYFACILITY NUMBER:
430701361
ADMINISTRATOR:BATE, STEPHANIEFACILITY TYPE:
850
ADDRESS:2146 LINCOLN AVENUETELEPHONE:
(408) 266-8952
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:154CENSUS: 126DATE:
04/18/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Lucy Nunez and Smriti DattaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to provide the licensing reports to parents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Mandeep Kaur conducted an unannounced complaint investigation. LPA met with Site Supervisor, Lucy Nunez and Site Director, Smriti Datta, and explained the complaint allegation to them.

Site Supervisor and Site Director self-admitted that they have not been able to provide a copy of the licensing report dated 04/12/2024 with Type A citation(s) in a timely manner to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care. Site Supervisor and Site Director self-admitted that LIC9224 Acknowledgement of Receipt of Licensing Reports for Type A Deficiency issued on 04/12/2024 have not yet been completed and signed by parents as per AB633 requirements which posed immediate health, safety or personal rights risk to persons in care.

**Continue on next page**
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 07-CC-20240412125939
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ACTION DAY NURSERY
FACILITY NUMBER: 430701361
VISIT DATE: 04/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
**Continuation from 9099-A**

Based on interviews during the investigation process, the Department concludes that facility has failed to provide the licensing reports to parents. Therefore, the above allegation is SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

A Type A deficiency is being cited on the attached LIC 9099D form. Appeal rights given and exit interview
conducted with Site Director, Smriti Datta.

LPA informed Site Director that this report dated 04/18/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Assembly bill 633 was provided and discussed with Site Supervisor and Site Director. LPA informed the Site Supervisor and Site Director to provide a copy of this licensing report dated 04/18/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 07-CC-20240412125939
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 04/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/19/2024
Section Cited
HSC
1596.8595(c)(1-4)
1
2
3
4
5
6
7
HSC 1596.8595((c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.(2) Upon enrollment of a new child in a facility...(3)recipient to sign(4)keep verification of receipt on child's file...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Site Director will submit to LPA proof that LIC9224 Acknowledgment of Receipt of Licensing forms was provided to parents/guardians of each child enrolled by POC due date 04/19/2024.
8
9
10
11
12
13
14
Based on interviews, Site Supervisor and Site Director self- admitted that LIC9224 Acknowledgement of Receipt of Licensing Reports for Type A Deficiency issued on 04/12/2024 have not yet been completed and signed by parents as per AB633 requirements which posed immediate health, safety or personal rights risk to persons 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.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 07-CC-20240412125939
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ACTION DAY NURSERY
FACILITY NUMBER: 430701361
VISIT DATE: 04/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
**Continuation from 9099 on 04/18/24**

Site Director stated that training on supervision and children safety will be provided to the staff on 04/18/2024 and the teacher involved was terminated on 04/12/2024.

As a result of the inspection on 04/12/2024, Type A citation was issued. Therefore, no deficiency issued as a result of today’s inspection.

Exit interview conducted and report was reviewed with Site Director, Smriti Datta. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5