434406818-1-9-2024-07-CC-SCES-D2PNQ3-20240222093912

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434406818
Report Date: 01/09/2024
Date Signed: 01/09/2024 09:10:50 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
09/20/2023 and conducted by Evaluator Teodoro Trujillo

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20230920090133

FACILITY NAME:	MADRIGAL, MARIA LOURDES		FACILITY NUMBER:	434406818
ADMINISTRATOR:	MADRIGAL, MARIA LOURDES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 286-7904
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95110
CAPACITY:	14	CENSUS: 7	DATE:	01/09/2024
		ANNOUNCED	TIME BEGAN:	08:16 AM
MET WITH:	Maria Lourdes Madrigal		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

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Due to lack of supervision, day care children sustained injuries

INVESTIGATION FINDINGS:

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On 01/09/2024 at 8:15 AM., Licensing Program Analyst (LPA) met with licensee Maria Lourdes-Madriogal to deliver findings for the above allegation. Licensee was present with 6 children in care: 3 infants, 3 preschool age. Licensee sister who helps with day care was outside with one preschool age child and two school age children waiting for school bus for one child. Assistant left to drop off her child to school with preschool age child.
LPA Trujillo explained the nature of the visit to her.

LPA previously conducted interviews and reviewed files. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro Trujillo	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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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