434413934-6-29-2023-07-CC-DSTN-CTTMW8-20230717095753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434413934
Report Date: 06/29/2023
Date Signed: 06/29/2023 11:18:17 AM

Substantiated

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
05/05/2023 and conducted by Evaluator Harsimran Kaur

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20230505102138

FACILITY NAME:	PATEL, DEEPA DARSHANKUMAR		FACILITY NUMBER:	434413934
ADMINISTRATOR:	PATEL, DEEPA DARSHANKUMAR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 642-1913
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	14	CENSUS: 5	DATE:	06/29/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Deepa Darshankumar Patel		TIME COMPLETED:	11:55 AM

ALLEGATION(S):

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Day care child sustained injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kaur conducted an unannounced complaint investigation and met with Licensee Deepa Darshankumar Patel. Purpose of today’s inspection: deliver investigation findings. LPA also observed 5 children and 1 staff at the facility during today's complaint investigation.

Based on the available evidence, record reviews and interviews conducted, it is concluded that the a day care child sustained injuries while in the facility's care. The preponderance of evidence standard has thus been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12 & Chapter 1), is being cited on the attached LIC 9099-D. Copy of appeal rights provided to Licensee, prior to conclusion of today’s inspection.

A Notice of Site Visit is issued and must be posted near the entrance of the facility along with a copy of today's report for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (408) 529-3696
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

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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Control Number 07-CC-20230505102138

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PATEL, DEEPA DARSHANKUMAR	FACILITY NUMBER: 434413934
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/29/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/29/2023 Section Cited HSC 102423(a)(2)	1 2 3 4 5 6 7	To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee put padding on pavement. Licensee will also pay extra attention to children while they play in the backyard.
	8 9 10 11 12 13 14	Based on record reviews and interviews. staff admitted to the allegation. Specifically, Child pushed another child from slide. Child hit her head on the pavement and sustained injury at the day care. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (408) 529-3696
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
05/05/2023 and conducted by Evaluator Harsimran Kaur

COMPLAINT CONTROL NUMBER: 07-CC-20230505102138

FACILITY NAME:	PATEL, DEEPA DARSHANKUMAR		FACILITY NUMBER:	434413934
ADMINISTRATOR:	PATEL, DEEPA DARSHANKUMAR		FACILITY TYPE:	810
ADDRESS:	1694 BELLEVILLE WAY		TELEPHONE:	(408) 642-1913
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	14	CENSUS: 5	DATE:	06/29/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Deepa Darshankumar Patel		TIME COMPLETED:	11:55 AM

ALLEGATION(S):

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Provider does not provide adequate supervision resulting in day care child engaging in inappropriate behavior with another day care child.
Provider did not seek medical attention to day care child.
Provider did not provide incident report to responsible party.
Provider did not communicate with responsible party.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Harsimran Kaur conducted an unannounced follow-up complaint investigation and met with Deepa Patel Darshankumar, Licensee. Purpose of today's follow up complaint investigation: deliver investigation findings.The investigation of the complaint allegations listed above was conducted by LPA Kaur. Based on interviews, record reviews, observations, 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.

A Notice of Site Visit was provided to Licensee, Deepa Darshankumar Patel, and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (408) 529-3696
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

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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