434408702-5-8-2020-07-CC-DSTN-BPHNBD-20200511101855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434408702
Report Date: 05/08/2020
Date Signed: 05/08/2020 05:14:13 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
02/13/2020 and conducted by Evaluator Dung Mac

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20200213162954

FACILITY NAME:	MARDUENO, ARACELI		FACILITY NUMBER:	434408702
ADMINISTRATOR:	MARDUENO, ARACELI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 445-2958
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	14	CENSUS: 0	DATE:	05/08/2020
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Araceli Mardueno		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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- Day care child sustained injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dung Mac conducted a Tele-Investigation via video conference call with Licensee Araceli Mardueno. The finding for the above allegation was delivered to the facility during this Tele-Investigation. Licensee was informed that due to COVID-19 situation and "Shelter In Place" Order, this LIC 9099 Complaint Investigation Report will be emailed to the Facility with "Read Receipt" notification in lieu of a physical visit to the facility.

During the course of the investigation, children and staff were interviewed, and children and staff files were reviewed. Based on the interviews and records reviewed obtained through investigation, LPA concluded that although the allegation that day care child sustained injuries while in care, 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 is therefore UNSUBSTANTIATED.

Exit interview was conducted, where this report was reviewed with Licensee over tele-investigation. A Notice of Site Visit will be sent to Facility via email and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2020

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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