<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434410773
Report Date: 05/15/2020
Date Signed: 05/15/2020 01:54:31 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
02/24/2020 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20200224115530
FACILITY NAME:VARGAS CDCFACILITY NUMBER:
434410773
ADMINISTRATOR:BEATRICE MARTINEZFACILITY TYPE:
850
ADDRESS:1054 CARSON DRIVETELEPHONE:
(408) 736-0174
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:45CENSUS: 0DATE:
05/15/2020
ANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Beatrice MartinezTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child sustained unexplained injury(s) while in care

Facility staff are not providing adequate supervision to children in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mel Matos conducted an announced tele-investigation via FaceTime with Beatrice Martinez, director. Purpose of today's tele-inspection: deliver investigation findings.

The investigation into the following allegations: 1) Day care child sustained unexplained injury(s) while in care and 2) Facility staff are not providing adequate supervision to children in care was conducted by Mel Matos. Based on the available evidence, interviews, and LPA’s observations during the complaint investigation inspection, it is concluded that although the allegations noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED.
Unsubstantiated
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: 05/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2020
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-20200224115530
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: VARGAS CDC
FACILITY NUMBER: 434410773
VISIT DATE: 05/15/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Matos informed Beatrice that due to the COVID-19 shelter in place order, today's Complaint Investigation Report (LIC 9099) along with a copy of the Notice of Site Visit will be emailed to the Facility (email: center50553@cdicdc.org ) with a "read receipt" notification. Beatrice agreed to respond to LPA's email within 24 hours acknowledging receipt of today's report.

Beatrice understands that the Notice of Site Visit must be posted in a visible location of the home for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2