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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430709448
Report Date: 03/01/2023
Date Signed: 03/01/2023 09:44:37 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 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
02/21/2023 and conducted by Evaluator Pietro Hernandez
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230221123411
FACILITY NAME:PRIMARY PLUS - INFANTSFACILITY NUMBER:
430709448
ADMINISTRATOR:LOPEZ, LORENAFACILITY TYPE:
830
ADDRESS:18720 BUCKNALL ROADTELEPHONE:
(408) 370-0350
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:83CENSUS: DATE:
03/01/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Lorena LopezTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Facility operating out of ratio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Pete Hernandez conducted an unannounced subsequent complaint visit today. LPA met with Director Lorena Lopez.

On 2/15/2023, LPA conducted a required 1 year inspection. LPA observed the facility was operating within licensed ratio. On 2/23/2023: LPA conducted an initial complaint investigation of the above allegations. The Director Lorena Lopez and staff were interviewed. LPA secured copy of the children's roster, timecards, Sign in and sign out sheets, and records of staff and room assignments and room census for the week of 2/13/2023. On 3/1/2023 the LPA observed the facility operation was within ratio. On all three occasions the facility was in ratio. LPA conducted several additional interviews with staff through out the investigation.

Based on the LPA’s observations, interviews and information obtained throughout the investigation, the allegations are UNSUBSTANTIATED. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
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-20230221123411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PRIMARY PLUS - INFANTS
FACILITY NUMBER: 430709448
VISIT DATE: 03/01/2023
NARRATIVE
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An exit interview was conducted. This report was discussed and left with the Licensee, Lorena Lopez, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2