434400492-1-12-2023-07-CC-JSEA-CP2V4G-20230214150619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434400492
Report Date: 01/12/2023
Date Signed: 01/12/2023 10:27:50 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
12/30/2022 and conducted by Evaluator Marilou Monico

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20221230160016

FACILITY NAME:	KIDANGO VALLEY MEDICAL CENTER		FACILITY NUMBER:	434400492
ADMINISTRATOR:	GRAY, STACIE		FACILITY TYPE:	830
ADDRESS:	730 EMPEY WAY		TELEPHONE:	(408) 429-2683
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	13	CENSUS: 7	DATE:	01/12/2023
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Stacie Gray		TIME COMPLETED:	10:40 AM

ALLEGATION(S):

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Facility staff threatened day care child.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Marilou Monico and Cynthia Tamayo made an unannounced follow-up complaint inspection and to deliver investigation findings. LPAs met with Site Director, Stacie Gray, and explained the nature of today's visit.

During the course of the investigation, staff and parents were interviewed, records were reviewed, and pertinent documents were obtained. Based available information, it is concluded that although the allegation noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

The allegation that facility staff threatened day care child is UNSUBSTANTIATED.

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: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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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