434413685-2-11-2020-07-CC-DSTN-BMKN5T-20200310101002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434413685
Report Date: 02/11/2020
Date Signed: 02/11/2020 02:59:51 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
01/14/2020 and conducted by Evaluator Dung Mac

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20200114092144

FACILITY NAME:	APPLESEED MONTESSORI SCHOOL		FACILITY NUMBER:	434413685
ADMINISTRATOR:	MARCIA TAI		FACILITY TYPE:	850
ADDRESS:	972 SOUTH DE ANZA BLVD		TELEPHONE:	(408) 470-4701
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	171	CENSUS: 122	DATE:	02/11/2020
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Veronica Uitz		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Lack of supervision resulting in day care child bitten by another child.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dung Mac and Licensing Program Manager (LPM) Diana Stephenson arrived at the facility at 9:00am and met with Interim Site Director, Veronica Uitz, for a follow-up on the complaint investigation.

LPA interviewed staff and children, and reviewed staff & children's files during investigation. In concluding the investigation, although the allegation noted on this complaint (lack of supervision resulting in daycare child bitten by another child), 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 therefore UNSUBSTANTIATED.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY AND MUST REMAIN POSTED FOR 30 DAYS.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

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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