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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434409633
Report Date: 07/15/2022
Date Signed: 07/15/2022 11:07:14 AM

Substantiated


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
07/11/2022 and conducted by Evaluator Araceli Almaraz
COMPLAINT CONTROL NUMBER: 07-CC-20220711120701

FACILITY NAME:CASTRO, KIMFACILITY NUMBER:
434409633
ADMINISTRATOR:CASTRO, KIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 600-8280
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 2DATE:
07/15/2022
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Licenssee Castro, KimTIME COMPLETED:
10:51 AM
ALLEGATION(S):
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Facility has ants inside.
INVESTIGATION FINDINGS:
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On this day Licensing Program Analysts (LPAs) Almaraz, Celi and Mac, Dung conducted an unannounced ten-day complaint investigation. LPAs met with Castro, Kim Licensee and discussed the complaint allegation/s. LPAs conducted interviews, toured the facility and reviewed facility documents. LPAs obtained a roster. There were two children in care during todays visit, one infant and school aged. “Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of
evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1, Article 06), are/is being cited (one Type B deficiency) on the attached LIC. 9099D

NOTICE OF SITE VISIT ISSUED AND MUST BE POSTED FOR 30 DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
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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Control Number 07-CC-20220711120701
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CASTRO, KIM
FACILITY NUMBER: 434409633
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2022
Section Cited
CCR
102417(b)
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Operation of Family Child Care Home:The home shall be kept clean and orderly. Requirement was not met as evidenced by LPAs Almaraz & Dung observed one ant on counter and one on floor. This poses a potential risk to the health and safety of the children in care.
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Licensee made appointment with APTIVE Pest Control last week and are scheduled for fumigation on 07/23/22. Licensee agreed to email LPA with proof of completion by 07/25/22, and understands a follow up visit may be required. araceli.almaraz@dss.ca.gov
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3