430709377-4-30-2020-07-CC-ASTR-BP6UPY-20200430154618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430709377
Report Date: 04/24/2020
Date Signed: 04/30/2020 03:31:37 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
02/07/2020 and conducted by Evaluator Mahvash Behbood

COMPLAINT CONTROL NUMBER: 07-CC-20200207083000

FACILITY NAME:	PRIMARY PLUS		FACILITY NUMBER:	430709377
ADMINISTRATOR:	CHAPA, MELISSA		FACILITY TYPE:	850
ADDRESS:	18720 BUCKNALL ROAD		TELEPHONE:	(408) 370-0357
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	278	CENSUS: 0	DATE:	04/24/2020
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Melissa Chapa		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility is out of ratio

INVESTIGATION FINDINGS:

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A Tele-inspection was made by Analyst Behbood to further investigate the above allegations and deliver the finding. The Tele-inspection was made via Face Time.
Melissa Chapa stated the facility is currently closed due to Covid-19 crises. She further clarified the attendance and staff present on the specific date.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

It was explained to Melissa that this report will be emailed to elquito@actiondayprimaryplus.com address for her review. it was further explained that "Read Receipt" will be consider as her signature.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash Behbood	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2020

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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