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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430710492
Report Date: 07/28/2022
Date Signed: 07/28/2022 04:05:23 PM

Substantiated


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
07/20/2022 and conducted by Evaluator Janette Cruz
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220720100651
FACILITY NAME:ACTION DAY NURSERYFACILITY NUMBER:
430710492
ADMINISTRATOR:STRANGE, BRITTANYFACILITY TYPE:
830
ADDRESS:3030 MOORPARK AVENUETELEPHONE:
(408) 249-0668
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:97CENSUS: 68DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
01:47 PM
MET WITH:Madison GatesTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility failed to keep facility clean, safe, and sanitary
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janette Cruz met with Madison Gates, Infant Center Director, for an unannounced complaint investigation. LPA discussed the complaint allegations with the Director and obtained a current Child Care Facility Roster, Personnel Report (LIC 500), and staff contact information. LPA also toured the seven classrooms with 68 children and 23 staff during today's inspection.

LPA observed and taken photos of rodent droppings in one of the infant classrooms (Room 6). LPA also observed presence of two mouse traps located near the washer and at the back of the fridge in the same room, therefore, the above allegation is SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

Type A deficiency is being cited on the attached LIC 9099D form.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS AS WELL AS THE TYPE A VIOLATION.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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 2
Control Number 07-CC-20220720100651
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: ACTION DAY NURSERY
FACILITY NUMBER: 430710492
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2022
Section Cited
CCR
101238(a)(1)
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Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

(1) The licensee shall take measures to keep the center free of flies, other insects, and rodents.
This requirement was not met as evidenced by:
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Licensee will submit a written plan to keep the classrooms and facility grounds clean, sanitary and free of rodents. Licensee has set up mouse traps on the affected classroom and areas where mouse sightings were reported. Licensee will provide proof of professional pest control service to LPA by POC due date.
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Based on observation and interviews, licensee did not comply with this section. LPA observed presence of rodent droppings in infant Room 6 which poses an immediate health, safety or personal rights risk to persons 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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2