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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430710075
Report Date: 12/19/2019
Date Signed: 12/19/2019 10:27:33 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
10/25/2019 and conducted by Evaluator Shannel Reed
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20191025161246
FACILITY NAME:PRIMARY PLUS - HIBISCUS (INFANTS)FACILITY NUMBER:
430710075
ADMINISTRATOR:JACQUELINE CATTOLICOFACILITY TYPE:
830
ADDRESS:801 HIBISCUS LANETELEPHONE:
(408) 985-5998
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:106CENSUS: 36DATE:
12/19/2019
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Chrisitani SherwoodTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Daycare child is allergic to dairy and drank milk.
Daycare child drank another daycare child’s milk.
Staff not preventing daycare child from eating off the ground.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Shannel Reed, made an unannounced complaint inspection follow up to the facility today to deliver complaint investigation findings. LPA met with Infant Center Director, Christiane Sherwood, and informed her of the reason for today’s inspection. LPA reviewed the allegations that a daycare child is allergic to dairy and drank milk, a daycare child drank another daycare child’s milk, and that staff are not preventing daycare child from eating off the ground.
Due to conflicting information obtained from interviews with staff and parents regarding the child’s access to milk and whether it was observed that the child drank the milk cannot be determined at this time. In regard to the allegation that staff are not preventing daycare child from eating off the ground, LPA conducted interviews with the staff and parents on the policy and practice of the children’s eating area and the staff’s practice of cleaning the floors after each meal. LPA received conflicting information from these interviews as to what was allegedly observed and what is reported to be the general practice in the classroom and while out outside on the play yard.
Report dated 12/19/19 to be continued on next page:
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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 3
Control Number 07-CC-20191025161246
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 - HIBISCUS (INFANTS)
FACILITY NUMBER: 430710075
VISIT DATE: 12/19/2019
NARRATIVE
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Report dated 12/19/19 continued from previous page:
Therefore, LPA concludes that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated.
NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3