434409329-9-27-2019-07-CC-MSEA-BGQVD9-20191007162018

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434409329
Report Date: 09/27/2019
Date Signed: 09/27/2019 04:07:14 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
07/16/2019 and conducted by Evaluator Janet Tse

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20190716153714

FACILITY NAME:	MARTINEZ, ANA		FACILITY NUMBER:	434409329
ADMINISTRATOR:	ANA MARTINEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 926-1903
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	14	CENSUS: 6	DATE:	09/27/2019
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Ana Martinez		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Adult in home hit day care child.
Adult in home yelled at day care child.
Adult in home inappropriately disciplined day care child.
Adult in home choked day care child.

INVESTIGATION FINDINGS:

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LPA Janet Tse met with licensee Ana Martinez to deliver findings of the above allegation. LPA explained the nature of today's visit to Licensee. LPA observed six children including one infant in the home with Licensee and her husband, Jorge Martinez, AKA Alfredo.

LPA was planning to interview a school age child who has not been present during LPA's investigation visits. However, the child has left the child care home and is currently attending an after school program at the school. The child is no longer coming to the child care home. LPA has reviewed files, conducted interviews, and made observations during the course of the investigation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are 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: 09/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

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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