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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434400052
Report Date: 02/15/2023
Date Signed: 02/15/2023 12:00:15 PM

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
01/10/2023 and conducted by Evaluator Marilou Monico
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230110090402
FACILITY NAME:KIDSPARKFACILITY NUMBER:
434400052
ADMINISTRATOR:ALVARADO, LISAFACILITY TYPE:
850
ADDRESS:2858 STEVENS CREEK BLVD. #100TELEPHONE:
(408) 985-2599
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:60CENSUS: 16DATE:
02/15/2023
UNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Sandra LunaTIME COMPLETED:
12:10 PM
ALLEGATION(S):
1
2
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9
Lack of staff supervision resulting in child being injured by another child.
Staff did not notify day care child's authorized representative of incident.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
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13
Licensing Program Analyst (LPA) Marilou Monico met with teacher, Sandra Luna, for a follow-up complaint investigation inspection and to deliver findings. Today, LPA toured the facility and interviewed children.

Based on evidence gathered, including interviews, record reviews, documents obtained, and observations, it is concluded that although the allegations noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. The allegations are UNSUBSTANTIATED. .

There were no deficiencies cited.

Exit interview conducted and report was reviewed with teacher, Sandra Luna.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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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