434413739-10-27-2020-07-CC-DSTN-BUZVAK-20201103151602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434413739
Report Date: 10/27/2020
Date Signed: 10/27/2020 01:53:12 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
09/17/2020 and conducted by Evaluator Ofelia Calivo

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20200917101735

FACILITY NAME:	BAXTER, KRISTIN & JEFFREY		FACILITY NUMBER:	434413739
ADMINISTRATOR:	KRISTIN & JEFFREY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 568-5484
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	14	CENSUS: 5	DATE:	10/27/2020
		ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	KRISTIN BAXTER		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Licensee pulled the ear of child in care.

Licensee verbally abused child in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Mel Matos and Ofelia Calivo conducted an announced tele-investigation via FaceTime (408) 568-5484 with Kristin Baxter, co-licensee. Purpose of today's tele-investigation: deliver investigation findings. The investigation into the following allegations was conducted by LPAs Mel Matos and Ofelia Calivo: 1) Licensee pulled the ear of child in care. 2) Licensee verbally abused child in care. Based on the available evidence and interviews completed for the complaint investigation, it is concluded that although the allegations noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED. LPA Calivo to forward a copy of today’s report to Kristin Baxter, co-licensee, via email (kikibaxx@comcast.net). LPA requested that Kristin respond to the “read receipt” confirmation/send confirmation of receipt email to LPA within 24 hours confirming receipt of today’s report. A Notice of Site Visit will be forwarded to Kristin via email and will be required to be posted near the entrance to the day care for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020

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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