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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434410592
Report Date: 08/02/2023
Date Signed: 08/02/2023 11:22:16 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
07/24/2023 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230724090924
FACILITY NAME:ORCHARD, THEFACILITY NUMBER:
434410592
ADMINISTRATOR:MARIA ROXANNE RESUMAFACILITY TYPE:
830
ADDRESS:494 S. BERNARDO AVE.TELEPHONE:
(408) 789-2621
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:32CENSUS: 23DATE:
08/02/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Kellie Lund & Pam EricksonTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility washing machines have mold build up
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Mel Matos and Jessica Bongardt conducted an unannounced 10 day complaint investigation and met with Kellie Lund, operations manager, and Pamela Erickson, preschool director. LPAs discussed the complaint allegation with Kellie and Pamela and toured the Infant and Toddler rooms during today's investigation.

LPAs toured the Infant room and observed/inspected the existing Whirlpool front load washer and rubber door gasket of the washer door. LPAs observed mold that has saturated into the rubber material of the washer door gasket. LPAs did not observe any "wet" mold on the rubber door gasket of the washer door nor did LPAs smell any mold inside the washer.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
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 3
Control Number 07-CC-20230724090924
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: ORCHARD, THE
FACILITY NUMBER: 434410592
VISIT DATE: 08/02/2023
NARRATIVE
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Based on interviews, observations, and evidence gathered during the investigation process, the Department concludes that the above allegation is found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

A "Type B" deficiency is being cited on the attached LIC 9099-D. Exit interview conducted and report was reviewed with the preschool director, Pamela Erickson. Appeal rights was also provided to Pamela prior to conclusion of today's inspection.

Notice of site visit was issued and must remain posted for 30 days
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20230724090924
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: ORCHARD, THE
FACILITY NUMBER: 434410592
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
08/11/2023
Section Cited
CCR
101238(a)
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Building and Grounds: The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
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The Facility states that the front load washer in the Infant room will be replaced by 08/11/2023. The Facility will also be implementing procedures to inspect and clean the front load washers throughout the Facility periodically.
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LPAs observed mold that has saturated into the rubber material of the front load washer door gasket in the Infant room. This presents a potential risk to the health, safety, or personal rights of children in care.
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Proof of front load washer replacement and written procedures for inspecting and cleaning the front load washers throughout the Facility periodically shall be submitted to LPA Matos by 08/11/2023.
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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) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3