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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434412084
Report Date: 11/23/2021
Date Signed: 11/23/2021 11:05:55 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
08/20/2021 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210820161511
FACILITY NAME:OMALEKI, JANAFACILITY NUMBER:
434412084
ADMINISTRATOR:OMALEKI, JANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 779-4411
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:14CENSUS: 7DATE:
11/23/2021
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jana OmalekiTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Day care child sustained a fracture while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samantha Yip conducted an subquent complaint investigation for the above allegation. LPA met with LIcensee Jana Omaleki and explained the reason for the inspection. The purpose of this inspection was to deliver the findings.

The investigation of the above allegation was conducted by Community Care Licensing Division (CCLD) Investigator, Victoria McIntosh. Based on interviews, records reviews, and evidence gathered during the investigation process, the Department determines the day care child substained a fracture while in care to be UNSUBSTANTIATED, meaning, although, the above allegation may have happened or is valid, there is not a prepondence of evidence to prove the alleged violation did not did not occur.

No deficiencies were cited as a result of this investigation. Exit interview conducted and report was reviewed with Licensee Jana Omaleki. A Notice of Site Visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
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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