434412405-3-15-2023-07-CC-JSEA-CQP227-20230407170017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434412405
Report Date: 03/15/2023
Date Signed: 03/15/2023 11:45:36 AM

Unsubstantiated

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
03/10/2023 and conducted by Evaluator Marilou Monico

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20230310154111

FACILITY NAME:	GOOMER ACADEMY		FACILITY NUMBER:	434412405
ADMINISTRATOR:	DEEPTI GOOMER		FACILITY TYPE:	850
ADDRESS:	2920 FOWLER ROAD		TELEPHONE:	(408) 270-2000
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	74	CENSUS: 55	DATE:	03/15/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Deepti Goomer		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Staff spoke inappropriately to child

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Marilou Monico and Farida Raja conducted an unannounced complaint inspection. LPAs met with Program Director, Deepti Goomer, and discussed the above allegation. Based on interviews, record reviews, and evidence gathered during the investigation process, it is concluded that although the allegation noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with Program Director, Deepti Goomer.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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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