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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434410679
Report Date: 03/26/2021
Date Signed: 03/26/2021 12:14:54 PM



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
03/10/2021 and conducted by Evaluator Anna Morales
COMPLAINT CONTROL NUMBER: 07-CC-20210310131655
FACILITY NAME:NAVARRO, MARTHAFACILITY NUMBER:
434410679
ADMINISTRATOR:NAVARRO, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 824-5439
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:14CENSUS: 11DATE:
03/26/2021
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Martha NavarroTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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1. Child was hit in day-care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Morales conducted a Subsequent Tele-Investigation via tele-conference (via WhatsAp) call with Licensee Martha Navarro to inform her of the finding for the above allegation.

This report with LPA's signature will be emailed to the Licensee. lieu of Program Director's signature, her response to LPA's email will be the confirmation of receipt of this licensing report.


(page 1 of 2)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
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-20210310131655
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: NAVARRO, MARTHA
FACILITY NUMBER: 434410679
VISIT DATE: 03/26/2021
NARRATIVE
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Complainant alleges that, Child was hit in day care . LPA obtained information from the interviews that were conducted with the Licensee, staff, parents, and other parties involved. LPA, also, reviewed supporting documentation, which included the Facility Roster staff schedule. LPA, also, toured the day care during a video call with Licensee.

Based on the information obtained, although the allegation that Child was hit in day care, may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore, the allegation is found to be UNSUBSTANTIATED.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2