434410396-1-26-2024-07-CC-SCES-D3LVVZ-20240322164706

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434410396
Report Date: 01/26/2024
Date Signed: 01/26/2024 02:48:20 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
10/06/2023 and conducted by Evaluator Teodoro Trujillo

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20231006151813

FACILITY NAME:	ESTRADA-GIRON, ADELA		FACILITY NUMBER:	434410396
ADMINISTRATOR:	EDELA EG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 229-0480
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	14	CENSUS: 0	DATE:	01/26/2024
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Adela Estrada-Giron		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Licensee yells at day care children while in care.

INVESTIGATION FINDINGS:

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On 01/26/24 at 12:15 PM., Licensing Program Analyst (LPA) Teodoro Trujillo met with licensee Adela Estrada-Giron to deliver findings for the above allegation. The licensee was not providing care to children today. Present with the licensee was her adult daughters Yoselyn and Lizbeth. LPA Trujillo explained the nature of the visit them. This report supersede previous LIC 9099 from 12/20/23.

LPA Trujillo previously conducted interviews and reviewed files.

Based on LPA observations, record review(s), and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

continued on next page, Page 1 of 2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro Trujillo	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 5

Control Number 07-CC-20231006151813

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ESTRADA-GIRON, ADELA	FACILITY NUMBER: 434410396
	VISIT DATE: 01/26/2024

NARRATIVE

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Type A Deficiencies were cited during today's visit. LPA Teodoro Trujillo informed licensee Adela Estrada-Giron that this report dated 01/26/24 document(s) 1 (one) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Teodoro Trujillo informed the licensee Adela Estrada-Giron and Yoselyn, adult daughter who assist, to provide a copy of this licensing report dated 01/26/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the licensee Adela Estrada-Giron and Yoselyn Refugio-Estrada.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro Trujillo	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 07-CC-20231006151813

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ESTRADA-GIRON, ADELA	FACILITY NUMBER: 434410396
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/26/2024 Section Cited CCR 102423(a)(4)	1 2 3 4 5 6 7	102423 Personal Rights (a) TEach child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.	1 2 3 4 5 6 7	Licensee will submit a written of her understanding of title 22 CCR 102423 to the San Jose Regioanl Office by 01/27/24.
	8 9 10 11 12 13 14	Based on interviews, Licensee did not comply with section cited above: This Department conducted investigation and found this poses an immediate threat to health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Susy Cervantes	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro Trujillo	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
10/06/2023 and conducted by Evaluator Teodoro Trujillo

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20231006151813

FACILITY NAME:	ESTRADA-GIRON, ADELA		FACILITY NUMBER:	434410396
ADMINISTRATOR:	EDELA EG		FACILITY TYPE:	810
ADDRESS:	3081 WATER STREET		TELEPHONE:	(408) 229-0480
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	14	CENSUS: 0	DATE:	01/26/2024
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Adela Estrada-Giron		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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9

Licensee physically abuses day care children while in care.
Licensee emotionally abuses day care children while in care.

INVESTIGATION FINDINGS:

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On 01/26/24 at 12:15 PM., Licensing Program Analyst (LPA) Teodoro Trujillo met with licensee Adela Estrada-Giron to deliver findings for the above allegation. The license was not providing care to children today. Present with the licensee was her adult daughters Yoselyn and Lizbeth. LPA Trujillo explained the nature of the visit to her. This report supersede previous LIC 9099 from 12/20/23.

LPA previously conducted interviews and reviewed files. 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.

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: Susy Cervantes	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro Trujillo	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5