430710075-1-18-2023-07-CC-GKUN-CNMTDE-20230201133811

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430710075
Report Date: 01/18/2023
Date Signed: 01/18/2023 11:12:54 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
12/14/2022 and conducted by Evaluator Pietro Hernandez

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20221214132518

FACILITY NAME:	PRIMARY PLUS - HIBISCUS (INFANTS)		FACILITY NUMBER:	430710075
ADMINISTRATOR:	MERCEDES MENDOZA		FACILITY TYPE:	830
ADDRESS:	801 HIBISCUS LANE		TELEPHONE:	(408) 985-5998
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY:	106	CENSUS: 33	DATE:	01/18/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Veronica Uitz		TIME COMPLETED:	11:40 PM

ALLEGATION(S):

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Facility staff restrained daycare child.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pete Hernandez conducted an unannounced subsequent complaint visit today. LPA met with Director Veronica Uitz.

On 12/15/2022: LPA conducted an initial complaint investigation of the above allegations. The Director was present.

Based on the interviews conducted with staff and record reviews, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the above allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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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Control Number 07-CC-20221214132518

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 - HIBISCUS (INFANTS)	FACILITY NUMBER: 430710075
	VISIT DATE: 01/18/2023

NARRATIVE

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LPA conducted an investigation on the alleged restraint of day-care child by facility staff. Based on RP’s statement, on 11/09/2022, RP observed a teacher holding RP’s child and restraining child’s movement to take child’s temperature using a digital thermometer. RP stated child was protesting and crying.

Based on interview with the teacher, teacher claims to have held and embraced the child so the thermometer would not fall from the child's armpit and released the child when the RP walked into the classroom because when the child saw RP, the child wanted to get up from the chair to move towards RP. The Teacher stated she was not restraining the child and was only attempting to take the child's temperature. There were no other witnesses identified.

Based on the interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the above allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A deficiency is NOT being cited. An exit interview was conducted with the Licensee. A copy of this report and was discussed and left with the Licensee's Representative, Veronica Uitz, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

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