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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434406751
Report Date: 11/08/2023
Date Signed: 11/08/2023 10:07:58 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
08/25/2023 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230825134817
FACILITY NAME:KIDANGO ARBUCKLEFACILITY NUMBER:
434406751
ADMINISTRATOR:LINDSAY MASUDAFACILITY TYPE:
850
ADDRESS:1910 CINDERELLA LANETELEPHONE:
(408) 905-8985
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:40CENSUS: 28DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Vanessa PaizTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child sustained unexplained bruising.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Mel Matos and Sheena Chin conducted an unannounced follow-up complaint investigation and met with Vanessa Paiz, director. Purpose of today's follow up complaint investigation: deliver investigation findings. The investigation of the complaint allegation listed above was conducted by LPA Matos. Based on interviews, record reviews, and evidence gathered during the investigation process, 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 that the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with the director, Vanessa Paiz. No deficiencies issued. A notice of site visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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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