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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434409633
Report Date: 09/09/2022
Date Signed: 09/29/2022 01:08:47 PM

Unsubstantiated


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
PUBLIC
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:
09/09/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Castro, KimTIME COMPLETED:
09:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child sustained injuries while in care.
Licensee left day care child in soiled diapers for an extended period of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day Licensing Program Analysts (LPAs) Almaraz, Celi and Cruz, Janette conducted an unannounced subsequent complaint investigation at the facility. Present were Licensee and two infants in care. LPAs spoke with Licensee Castro, Kim and discussed the findings for the above allegations.

During the course of the investigation, LPAs obtained a roster, reviewed records, and conducted interviews, it is concluded that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED .” There were no deficiencies cited during today's visit.

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

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
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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