<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430710536
Report Date: 09/21/2022
Date Signed: 09/21/2022 02:43:04 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
08/03/2022 and conducted by Evaluator James G Santos
COMPLAINT CONTROL NUMBER: 07-CC-20220803114503
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: 26DATE:
09/21/2022
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Lucille GabrielTIME COMPLETED:
03:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff handled child in a rough manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), James Santos conducted an unannounced subsequent complaint visit investigation today and met with Program Director, Lucille Gabriel. The purpose of today's visit was to deliver the investigation finding for the above allegation.

During the course of the investigation, interviews were conducted with staff and third party agency representative. Based on the interview about the incident, a child brought a backpack in school. But due to the school's COVID19 policy, backpacks or any items from home are not allowed to be brought inside the classrooms. The staff advised the child's Responsible Party about the policy. However, the child insisted to bring his backpack in the classroom. Per interview, the staff attempted to take the backpack from the child and as a result, the child fell and hit his head. There was no injury observed on the child.

Based on the information gathered, the preponderance of evidence standard have been met, therefore the above allegation is found to be SUBSTANTIATED.

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


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.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
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-20220803114503
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2022
Section Cited
CCR
101223(a)(1)
1
2
3
4
5
6
7
101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Program Director agreed to conduct training with staff regarding Personal Rights. Program Director will submit Proof of training to CCL by the POC due date, 10/21/2022.
8
9
10
11
12
13
14
Based on the report, a child brought a backpack in school. But due to the school's COVID19 policy, backpacks or any items from home are not allowed to be brought inside the classrooms. However, the child insisted to bring his backpack in the classroom. Per interview, the staff attempted to take the back from the child and as a result, the child fell and hit his head. There was no injury observed on the child. This poses a potential risk to the Health, Safety or Personal Rights to children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2