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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434410396
Report Date: 02/06/2024
Date Signed: 02/06/2024 02:12:19 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
01/04/2024 and conducted by Evaluator Fermin Campos-Jaramillo
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240104163712
FACILITY NAME:ESTRADA-GIRON, ADELAFACILITY NUMBER:
434410396
ADMINISTRATOR:EDELA EGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 229-0480
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 0DATE:
02/06/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Adela Estrada-GironTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Licensee does not properly supervise children.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met with Adela Estrada-Giron, licensee, for a follow up complaint investigation. The purpose of today’s inspection: Deliver the findings for the allegation stated above.
LPA observed there were not children in care present today.
Based on interviews, and information gathered during the investigation process, it is thus concluded that the above allegation is found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

One type B was cited today.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Susy CervantesTELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
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 2
Control Number 07-CC-20240104163712
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: 02/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/13/2024
Section Cited
CCR
102417(a)
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Operation of a Family Child Care Home.
a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times...
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Licensee shall submit a written letter stating she understands that licensee shall provide care and supervision all the time to the children in care, and accompany them when they need to recover something from the neighbor's house.
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During the investigation, Licensee has stated that in the past, the children in her care have entered without her supervision the neighbor's house with the purpose of recovering toys and balls.
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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: Susy CervantesTELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
LIC9099 (FAS) - (06/04)
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