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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434413114
Report Date: 11/09/2022
Date Signed: 11/09/2022 12:26:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 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
09/29/2022 and conducted by Evaluator Kassandra Medrano
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220929094222
FACILITY NAME:WILLOWS NURSERY SCHOOL, THEFACILITY NUMBER:
434413114
ADMINISTRATOR:ASHLEY ESTRELLAFACILITY TYPE:
850
ADDRESS:1149 MINNESOTA AVENUETELEPHONE:
(408) 352-5601
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:17CENSUS: 14DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Leydi ChavezTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide adequate supervision for child in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 9th, 2022 at 11am Licensing Program Analyst (LPA), Kassandra Medrano, conducted an unannounced subsequent complaint inspection to deliver findings of the investigation. LPA met with Director, Leydi Chavez and explained the nature of today's inspection.

LPA Medrano conducted interviews,toured the facility and obtained copies of pertinent information. Based on information obtained; there is not enough evidence to prove that the above allegation has occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegations did or did not occur. Due to the above information, the allegations are UNSUBSTANTIATED.

NOTICE OF SITE VISIT WAS ISSUED AND SHALL BE POSTED FOR 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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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