430710075-7-24-2024-07-CC-JSEA-D8YSER-20240910134909

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430710075
Report Date: 07/24/2024
Date Signed: 07/24/2024 02:54:13 PM

Unsubstantiated

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
05/28/2024 and conducted by Evaluator Samantha Yip

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20240528145305

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: 27	DATE:	07/24/2024
		UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	Nicole Hughes and Sarah Holloway		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Facility is out of ratio

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation. LPA met with Regional Director, Nicole Hughes, and explained the reason for the inspection. Present during today's inspection were 27 infants and at least seven staff.

During the course of this investigation, LPA conduct observation. LPA also reviewed pertain documents. Based on the information obtained, the above allegation is found to be UNSUBSTANTIATED, meaning although, the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were issued as a result of this investigation. Exit interview conducted and report was reviewed with Director Sarah Holloway. A notice of site visit has been issued and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

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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