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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430710536
Report Date: 10/11/2023
Date Signed: 10/12/2023 10:33:15 AM

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
09/25/2023 and conducted by Evaluator Anna Morales
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230925150720
FACILITY NAME:YWCA DAVIDSONFACILITY NUMBER:
430710536
ADMINISTRATOR:RODRIGUEZ, JEANINEFACILITY TYPE:
850
ADDRESS:375 SOUTH THIRD STREETTELEPHONE:
(408) 295-4011
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY:67CENSUS: 17DATE:
10/11/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lucille GabrielTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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1. Facility is unsanitary
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Morales conducted a Subsequent visit to ideliver the findings for the above allegations. LPA was greeted by Program Director Lucille Gabriel

LPA conducted interviews with staff who stated that they have seen cockroaches at the facility, however, staff stated that they have not seen any evidence of rats. Interview(s) were, also, conducted with a pest control technician specialist who stated, "the roaches were found in the kitchen only not throughout the classrooms."

(continue on LIC9099C)

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
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 5
Control Number 07-CC-20230925150720
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: YWCA DAVIDSON
FACILITY NUMBER: 430710536
VISIT DATE: 10/11/2023
NARRATIVE
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Based on today's observation and on the information gathered, the preponderance of evidence standard have been met, therefore the above allegation: Facility is unsanitary is SUBSTANTIATED.

See LIC9099D page for deficiency cited. Exit interview conducted and copy of this report and appeal rights form provided to the Director Lucille Gabriel.

NOTICE OF SITE VISIT WAS ISSUED TO DIRECTOR AND WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 07-CC-20230925150720
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: YWCA DAVIDSON
FACILITY NUMBER: 430710536
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2023
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.
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Director stated that they have a Pest Control conducting monthly services. Next services is scheduled for November 3,2023. Director will implement a plan that will address the next step to erridicate the pest problem. Director will submit the plan by the POC date.
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(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: Cockroaches are present inside the facility, This poses a potential risk to the health, safety, and personal rights of 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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5