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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430710075
Report Date: 08/08/2024
Date Signed: 08/08/2024 04:36:32 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
08/02/2024 and conducted by Evaluator Jennifer Beehler
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240802132850
FACILITY NAME:PRIMARY PLUS - HIBISCUS (INFANTS)FACILITY NUMBER:
430710075
ADMINISTRATOR:MERCEDES MENDOZAFACILITY TYPE:
830
ADDRESS:801 HIBISCUS LANETELEPHONE:
(408) 985-5998
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:106CENSUS: 27DATE:
08/08/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Renee TorresTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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PHYSICAL PLANT - Temperature in center went over 85 degrees F.
False Claims
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Jennifer "Jen" Beehler & Samantha Yip conducted an unannounced complaint investigation for the above allegations. LPAs met with Director Renee Torres and explained the reason for the inspection.

During the course of this investigation, LPAs conducted interviews and reviewed records. Based on the information obtained, the above allegations are found to be SUBSTANTIATED, meaning the preponderance standard has been met.

Facility self reported to the San Jose Regional office that the center had a power outage on 07/24/2024. Regional Manager informed LPA Yip on 07/24/2024 that the temperature of the room had gone above 85 degrees Fahrenheit at 1:30PM and informed LPA that they closed the rooms where the temperature had gone over 85 degrees Fahrenheit. Based on interviews, one of the room had reached a temperature of 91 degree Fahrenheit at 1PM.
---------------------------------CONTINUES ON 9099 DATED 08/08/2024 PAGE 2--------------------------------
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
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-20240802132850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PRIMARY PLUS - HIBISCUS (INFANTS)
FACILITY NUMBER: 430710075
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2024
Section Cited
CCR
101238(a)(1)
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A comfortable temperature for children shall be maintained at all times.
The licensee shall maintain the temperature in rooms that children occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C).

This requirement is not been met as evidenced by:
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Center will submit a written plan on the strategy for when there is a power outages.
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Based on interview and record review, the center had a power outage on 07/24/2024. Staff interviews verifying the temperature had exceeded 85 degrees Fahrenheit and facility records showing logs of temperatures above 85 degrees Fahrenheit on 07/24/2024. This poses a potential health and safety risk for children in care.
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Type B
08/15/2024
Section Cited
CCR
101163(a)
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False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the child care center or any of the services provided by the center.
This requirements is not met as evidenced by:
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By POC 08/15/2024, facility will submit a written statement that they understand that cannot make any false claims to Licensing.
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Based on interview, LPA Yip was informed by Regional Manager that the temperature of the rooms had reached above 85 degree Fahrenheit at 1:30PM, however, one of the class at reached above 85 prior to 1:30PM. This poses a potential health and safety risk to children in care.
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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20240802132850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PRIMARY PLUS - HIBISCUS (INFANTS)
FACILITY NUMBER: 430710075
VISIT DATE: 08/08/2024
NARRATIVE
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-----------------------------------CONTINUATION OF 9099 DATED 080/08/2024 PAGE 1--------------------------

As a result of this investigation, two Type B citations were issued. Exit interview conducted and report was reviewed with facility representative, Renee Torres. A notice of site visit was issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3