434409025-9-13-2021-07-CC-MSEA-C6VNUX-20210915104701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434409025
Report Date: 09/13/2021
Date Signed: 09/13/2021 09:27:43 AM

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
08/10/2021 and conducted by Evaluator Susy Cervantes

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20210810110531

FACILITY NAME:	RIOS, AMPARO		FACILITY NUMBER:	434409025
ADMINISTRATOR:	RIOS, AMPARO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 972-1077
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	14	CENSUS: 3	DATE:	09/13/2021
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Maria Flores		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Personal Rights- Staff do not take any precautions for COVID-19

INVESTIGATION FINDINGS:

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On 09/13/2021 at 09:30 AM, Licensing Program Analyst (LPA), Susy Cervantes, met with licensee's assistant, Maria Flores, to deliver complaint findings. Present were licensee's assistant with 3 children in care: 3 preschool. Assistant stated licensee, Amparo Rios, had an appointment this morning.

Based on record review and interviews, 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.

An exit interview was conducted with licensee's assistant in Spanish. No deficiencies were cited during today's visit. Notice of SIte visit must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

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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