430709448-11-30-2021-07-CC-SKNT-C9BUFG-20211202143239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430709448
Report Date: 11/30/2021
Date Signed: 11/30/2021 12:29:26 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
11/15/2021 and conducted by Evaluator Pietro Hernandez

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20211115140240

FACILITY NAME:	PRIMARY PLUS - INFANTS		FACILITY NUMBER:	430709448
ADMINISTRATOR:	LOPEZ, LORENA		FACILITY TYPE:	830
ADDRESS:	18720 BUCKNALL ROAD		TELEPHONE:	(408) 370-0350
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	83	CENSUS: 42	DATE:	11/30/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Lorena Lopez		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff are not practicing safe sleep practices.

INVESTIGATION FINDINGS:

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On 11/17/2021: Licensing Program Analyst (LPA) Pietro Hernandez conducted an unannounced Subsequent Complaint Investigation at the Facility. LPA spoke with Director Lorena Lopez and discussed the finding for the above allegation.

During the course of the investigation, LPA inspected the Child Care Center, reviewed records, and conducted interviews with the Director, and Teachers. LPA Hernandez determined that the allegation is substantiated.

Continued on page 2 of LIC9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

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 3

Control Number 07-CC-20211115140240

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: PRIMARY PLUS - INFANTS	FACILITY NUMBER: 430709448
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/30/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/19/2021 Section Cited CCR 101439.1(f)	1 2 3 4 5 6 7	101439.1(f) Infant Care Center Sleeping Equipment: (f) Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The LPA verified that the Director informed the staff that this practice would no longer be practiced since it is not consistant with the Infant Safe Sleep Best Practices.
	8 9 10 11 12 13 14	The 12 month and under infant staff have been covering the infants with blankets to help them sleep while placed in the crib. The staff then removed them once the infant fell asleep. This poses a potential risk to the health and safety of the children 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.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 07-CC-20211115140240

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: PRIMARY PLUS - INFANTS	FACILITY NUMBER: 430709448
	VISIT DATE: 11/30/2021

NARRATIVE

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Continuation of Page 1 LIC9099

Allegation:

1) Facility staff are not practicing safe sleep practices.

LPA Hernandez did interview 4 staff and all 4 staff confirmed that the infants were placed in cribs with a blanket until the infant fell asleep. The line of questioning was initiated by the RPs statement and the blankets observed that were placed on some of the edges of the cribs. There was a unanimous testimony that the interviewed staff testified that they were engaging in this practice until the LPA initiated the on site investigation on 11/17/2021. After the LPA discussed this issue regarding Title 22 regulation: Infant Care Center Sleeping Equipment: 101439.1(f) Cribs shall be free from all loose articles and objects, including blankets and pillows. The Director immediately had a meeting with all of her staff and instructed them on the correct and acceptable practices for infants sleeping.

The Allegation is being Substantiated a deficiency is being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plan of Corrections were reviewed and developed with the Licensee. A copy of this report and appeals rights were 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: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

LIC9099 (FAS) - (06/04)

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