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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434402285
Report Date: 09/28/2022
Date Signed: 09/28/2022 03:24:28 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
08/09/2022 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220809113026
FACILITY NAME:LINDSETH, THERESAFACILITY NUMBER:
434402285
ADMINISTRATOR:LINDSETH, THERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 848-5051
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 6DATE:
09/28/2022
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Theresa LindsethTIME COMPLETED:
11:50 AM
ALLEGATION(S):
1
2
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9
Provider violated child's personal rights.
INVESTIGATION FINDINGS:
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2
3
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5
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7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation for the above allegation. LPA met with Licensee Theresa Lindseth and explained the reason for the inspection. Present during today's inspection were Licensee, a student volunteer, staff from Gavilan College, and 6 children.

During the course of this investigation, LPA interviewed Licensee, children, and third party. Based on the information obtained, the above allegation is found to be UNSUBSTANTIATED, meaning although, the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were issued as a results of this inspection. Exit interview conducted and report was reviewed with Licensee Theresa Lindseth. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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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