430703695-7-10-2019-07-CC-SKNT-BEL2S9-20190730173846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430703695
Report Date: 07/10/2019
Date Signed: 07/10/2019 11:43:15 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
05/14/2019 and conducted by Evaluator Shannel Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20190514120122

FACILITY NAME:	SJB - SAN JUAN BAUTISTA CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	430703695
ADMINISTRATOR:	NIKITTIN, YULIANA		FACILITY TYPE:	850
ADDRESS:	1945 TERILYN AVENUE		TELEPHONE:	(408) 259-4796
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95122
CAPACITY:	231	CENSUS: 121	DATE:	07/10/2019
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Linsay Masuda & Yuliana Nikittin		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of supervision resulted in inappropriate interactions between children in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Shannel Reed arrived at the facility today to conduct an unannounced complaint investigation to the facility today to interview additional teaching staff and deliver investigation findings regarding the allegation that lack of supervision resulted in inappropriate interactions between children in care. LPA met with the Regional Director, Yuliana Nikittin and Site Supervisor, Lindsay Masuda, and informed them of the purpose of today’s inspection. LPA interviewed additional staff and reviewed the complaint allegation with Ms. Nikittin and Ms. Masuda. Based on interviews conducted with teaching staff, children and parents, the information obtained supports the finding that there was inappropriate contact between children in care, and though there were teaching staff present, no teaching staff witnessed the contact to make appropriate efforts to prevent it. Therefore, it is concluded that the preponderance of evidence standard has been met and the above allegations are found to be SUBSTANTIATED. A Type B deficiency is being cited on the attached LIC 9099-D.
An exit review was conducted with Ms. Nikittin and Ms. Masuda.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
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)

Page: 1 of 2

Control Number 07-CC-20190514120122

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: SJB - SAN JUAN BAUTISTA CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 430703695
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/09/2019 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as	1 2 3 4 5 6 7	The Licensee shall develop and submit plan of correction that ensures that children are visually supervised in the classroom and on the playground at all times. The Licensee shall develop and submit plan to ensure that the teaching staff discuss with the children in care to ensure that they are aware of where and what is appropriate touching and what
	8 9 10 11 12 13 14	evidenced by: There was inappropriate interactions between children in care and though there were teaching staff present, no teaching staff witnessed the contact to make appropriate effort to prevent it. The Licensee understands this is a potential risk to the children in care.	8 9 10 11 12 13 14	s not. This plan will be submitted by the POC due date of August 09, 2019.
	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: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
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)

Page: 2 of 2