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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430703144
Report Date: 09/04/2024
Date Signed: 09/04/2024 02:41:40 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/29/2024 and conducted by Evaluator Melanie Otsuji
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240829111724
FACILITY NAME:ACTION DAY NURSERY-PRIMARY PLUSFACILITY NUMBER:
430703144
ADMINISTRATOR:JESSICA GUZMANFACILITY TYPE:
830
ADDRESS:333 EUNICE AVENUETELEPHONE:
(650) 967-3780
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY:60CENSUS: 44DATE:
09/04/2024
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Jessica SanchezTIME COMPLETED:
02:55 PM
ALLEGATION(S):
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- Staff do not ensure classrooms maintain correct ratio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conduct an initial inspection into the above allegation. LPA met with Facility Representative, Jessica Sanchez. Also present during today's visit were 14 additional staff members and 44 infant aged children.

During the course of the investigation LPA conducted observations and interviews. On today's date, 9/4/2024 around 1:55PM, although it was nap time, some children in Room C classroom were observed to be walking around, and off of their napping mats. Due to children being awake and walking about, facility must revert back to the ratio of 1 teacher to every 4 infants. LPA observed 2 staff members to 22 children in the classroom, causing them to be out of ratio. Based on LPAs observations and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED Health and Safety Code 1596.80 is being cited on the attached LIC. 9099D.

An exit interview and report reviewed with Facility Representative, Jessica Sanchez.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
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 52-CC-20240829111724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ACTION DAY NURSERY-PRIMARY PLUS
FACILITY NUMBER: 430703144
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
CCR
101416.5(b)
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Staff-Infant Ratio. There shall be a ratio of one teacher for every four infants in attendance.

This requirement is not being met as evidence by: Although most children were napping, some children were observed to be
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Facility representative is to create a plan to ensure that proper ratio is maintained at all times. Plan is to include how facility will ensure proper ratio during napping/waking/transition times. Plan to be emailed to LPA no later than 9/18/2024.
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up and walking around in the classroom. During this time there were 22 infant aged children present with 2 staff members. This has the potential to be a health and safety risk to children in care.
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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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
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