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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430710584
Report Date: 05/13/2022
Date Signed: 05/19/2022 11:02:43 AM

Unsubstantiated


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
03/14/2022 and conducted by Evaluator Elizabeth Larios
COMPLAINT CONTROL NUMBER: 07-CC-20220314155512
FACILITY NAME:KINDERWOOD CHILD DEVELOPMENT CENTER, INCFACILITY NUMBER:
430710584
ADMINISTRATOR:ULRICH, ELISEFACILITY TYPE:
830
ADDRESS:5560 ENTRADA CEDROSTELEPHONE:
(408) 363-1366
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:30CENSUS: 16DATE:
05/13/2022
UNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Elise Ulrich TIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Staff handled daycare child in a rough manner
Staff yells at daycare children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Elizabeth Larios conducted an unannounced complaint investigation to deliver investigation findings. LPA met with Executive Director, Elise Ulrich (Ms. Lee) and explained the purpose of today's visit was to deliver the investigation finding for the above allegations.

Based on the interviews, records review and observations, there is not enough evidence to prove that the above allegations occurred. Based on the information gathered, the allegation is UNSUBSTANTIATED. A finding that is unsubstantiated means although the allegation may have happened or is valid, the preponderance of evidence do not prove it.

Exit interview was conducted, where this report was reviewed and discussed with Elise Ulrich.

CONTINUE ON LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
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-20220314155512
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: KINDERWOOD CHILD DEVELOPMENT CENTER, INC
FACILITY NUMBER: 430710584
VISIT DATE: 05/13/2022
NARRATIVE
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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2