434407184-12-4-2019-07-CC-MSEA-BJKPHT-20191205102025

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434407184
Report Date: 12/04/2019
Date Signed: 12/04/2019 05:09:19 PM

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
08/02/2019 and conducted by Evaluator Janet Tse

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20190802161551

FACILITY NAME:	NEVAREZ, DIANETH & SOLORIO, GUADALUPE		FACILITY NUMBER:	434407184
ADMINISTRATOR:	NEVAREZ, D & SOLORIO, G		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 578-1437
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	14	CENSUS: 5	DATE:	12/04/2019
		UNANNOUNCED	TIME BEGAN:	04:45 PM
MET WITH:	Dianeth Nevarez		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Infant sustained broken arm while in care.

INVESTIGATION FINDINGS:

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LPA Janet Tse met with licensee Dianeth Nevarez to deliver findings for the above allegation. LPA explained the nature of today's visit to Licensee. LPA observed five children including one infant with licensees Dianeth Nevarez, Guadalupe Solorio and assistant Estela Lepe.

The Investigation Bureau has conducted and completed the investigation for the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation 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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019

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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