430710436-2-4-2022-07-CC-MSEA-CBDNGC-20220206092653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430710436
Report Date: 02/04/2022
Date Signed: 02/04/2022 10:35:22 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
11/01/2021 and conducted by Evaluator Susy Cervantes

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20211101133001

FACILITY NAME:	SCOTT LANE STATE PRESCHOOL		FACILITY NUMBER:	430710436
ADMINISTRATOR:	YIN YEE LEUNG		FACILITY TYPE:	850
ADDRESS:	1925 SCOTT BLVD		TELEPHONE:	(408) 423-4117
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95050
CAPACITY:	72	CENSUS: 12	DATE:	02/04/2022
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Jacqueline Robles		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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9

Personal Rights

INVESTIGATION FINDINGS:

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On 02/04/2022 at 10:0 AM, Licensing Program Analyst (LPA) Susy Cervantes met with teacher, Jacqueline Robles, to deliver complaint findings. Present were 2 teachers with 12 children in class #32.

The department has investigated the complaint by interviewing staff, children, parents, and record review. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with the facility representative, Jacqueline Robles. A notice of site visit was given and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022

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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