430710536-3-14-2023-07-CC-GKUN-CQBUXV-20230327155900

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430710536
Report Date: 03/14/2023
Date Signed: 03/14/2023 03:58:36 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 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
03/08/2023 and conducted by Evaluator Anna Morales

COMPLAINT CONTROL NUMBER: 07-CC-20230308085134

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: 12	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Betty Robles		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

1. Facility outdoor activity area is unsafe

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Progam Analyst (LPA) Anna Morales conducted an Initial Complaint Investigation
for the above allegation. LPA was greeted by Acting Director Betty Robles and contacted the Program Director by telephone to inform her of the above allegation.

LPA observed the Preschool classroom that is located on the second floor. The second preschool classroom uses its own playground that is adjacent to the classroom. There is a rail fence that faces the parking lot( on the first floor) and a split rail fence that is in the middle of the playground.

LPA measured the space of the inside of each railing( of the fence facing the parking lot)to be approximately 6 inches apart.
(continue on page 2)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

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 3

Control Number 07-CC-20230308085134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: YWCA DAVIDSON	FACILITY NUMBER: 430710536
	VISIT DATE: 03/14/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On November 17, 2022, LPA Morales conducted an ANNUAL REQUIRED INSPECTION and observed that the outdoor activity space was safe and the fence on the playground upstairs had a mesh material covering the iron fencing so that the space between the rails were not exposed.

During today's visit, LPA observed no mesh material covering the iron split rail fence, and the space between the rails were exposed.

Based on today's observation and on the information gathered, the preponderance of evidence standard have been met, therefore the above allegation: Facility outdoor activity area is unsafe 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 Acting Director Betty Robles.

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.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 07-CC-20230308085134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: YWCA DAVIDSON	FACILITY NUMBER: 430710536
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/14/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 03/31/2023 Section Cited CCR 101238.2(g)	1 2 3 4 5 6 7	Outdoor Activity Space:101238.2 (g) The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high.	1 2 3 4 5 6 7	The Director agreed to submit a plan to ensure that the second floor playground is enclosed by a fence that will protect the children at all times.
	8 9 10 11 12 13 14	This was not met as evidenced by: Today, 3/14/2023, LPA observed no mesh material covering the iron split rail fence which does not effectively prevent children from exiting the outdoor play area, which 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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3