430710536-9-14-2020-07-CC-SKNT-BTRMVQ-20200924095705

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430710536
Report Date: 09/14/2020
Date Signed: 09/14/2020 03:37:47 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
08/24/2020 and conducted by Evaluator Anna Morales

COMPLAINT CONTROL NUMBER: 07-CC-20200824155533

FACILITY NAME:	YWCA DAVIDSON		FACILITY NUMBER:	430710536
ADMINISTRATOR:	RODRIGUEZ, JEANINE		FACILITY TYPE:	850
ADDRESS:	375 SOUTH THIRD STREET		TELEPHONE:	(408) 295-4011
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	67	CENSUS: 67	DATE:	09/14/2020
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Lucille Gabriel		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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1. Facility staff handled child in a rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Morales conducted a Subsequent Tele-Investigation via telephone conference call with Program Director Lucille Gabriel to inform her of the finding for the above allegation.

This report with LPA's signature will be emailed to the Program Director. In lieu of Program Diector's signatue, her response to LPA's email will be the confirmation of receipt of this licensing report.

(page 1 of 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2020

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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Control Number 07-CC-20200824155533

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: YWCA DAVIDSON	FACILITY NUMBER: 430710536
	VISIT DATE: 09/14/2020

NARRATIVE

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Complainant alleges that Facility staff handled child in a rough manner by allegedly forcing the child’s head down during nap time. LPA obtained information from the interviews that were conducted with the Program Directors Teachers, Parents, and other Parties involved. LPA, also, reviewed supporting documentation, which included the Facility Roster, classroom assignment and the sign in and sign out sheet. LPA also toured the day care home during a video call with Licensee.

Based on the information obtained, although the allegation that Facility staff handled child in a rough manner by allegedly forcing the child’s head down during nap time 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.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2020

LIC9099 (FAS) - (06/04)

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