434413894-10-7-2022-07-CC-DSTN-CK6SW4-20221013141339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434413894
Report Date: 10/07/2022
Date Signed: 10/07/2022 09:42:47 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
07/27/2022 and conducted by Evaluator Janette Cruz

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20220727141757

FACILITY NAME:	NGUYEN,NGHIA HIEU		FACILITY NUMBER:	434413894
ADMINISTRATOR:	NGUYEN,NGHIA HIEU		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 401-9729
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	14	CENSUS: 6	DATE:	10/07/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Nghia Hieu Nguyen		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Licensee put tape on a child's mouth and put child in a closet .

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janette Cruz conducted an unannounced follow up complaint investigation and met with Nghia Hieu Nguyen, Licensee. Purpose of today's follow up complaint investigation: deliver investigation findings.

The investigation of the allegations listed above was conducted by LPA Cruz. Based on the available evidence including observations, record reviews and interviews completed for this 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.

A Notice of Site Visit was given and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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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