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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434412078
Report Date: 12/10/2019
Date Signed: 12/10/2019 09:40:44 AM



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
10/03/2019 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20191003120045
FACILITY NAME:AGRAWAL, SARIKAFACILITY NUMBER:
434412078
ADMINISTRATOR:AGRAWAL, SARIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 735-8571
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 6DATE:
12/10/2019
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sarika AgrawalTIME COMPLETED:
09:50 AM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Licensee hits children
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mel Matos met with Sarika Agrawal, Licensee, for a follow up complaint investigation inspection. Purpose of today's inspection: deliver investigation findings.
LPA interviewed the Licensee, one adult assistant, one adult volunteer, three day care children, and a random sampling of current and former day care parents for this investigation.
In concluding the investigation, LPA Matos concludes that although the allegation noted on this complaint (Licensee hits children), may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegation is thus UNSUBSTANTIATED.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME AND MUST REMAIN POSTED FOR 30 DAYS.
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: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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