430710492-1-6-2021-07-CC-ASTR-BY4ML6-20210210084145

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430710492
Report Date: 01/06/2021
Date Signed: 01/06/2021 04:01:46 PM

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
11/16/2020 and conducted by Evaluator Marilou Monico

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20201116150915

FACILITY NAME:	ACTION DAY NURSERY		FACILITY NUMBER:	430710492
ADMINISTRATOR:	SAMANTHA SILVA		FACILITY TYPE:	830
ADDRESS:	3030 MOORPARK AVENUE		TELEPHONE:	(408) 249-0668
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	97	CENSUS: 37	DATE:	01/06/2021
		ANNOUNCED	TIME BEGAN:	03:47 PM
MET WITH:	Samantha Silva		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Day-care child is not fed an adequate amount of food while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced subsequent complaint tele-inspection to deliver findings via Facetime due to Covid-19 pandemic. LPA met with Site Director, Samantha Silva. Site Director was advised that this Complaint Investigation Report (LIC 9099) will be emailed to her(mic@actiondayprimaryplus.com). Facility's reply to the email within 24 hours will serve as acknowledgement that the report was received.

Based on interviews and documents that were obtained during the investigation, although the allegation that day-care child is not fed an adequate amount of food while in care may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore, the allegation is found to be UNSUBSTANTIATED.

There we no deficiencies cited.

NOTICE OF SITE VISIT WAS ISSUED. SITE DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2021

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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