434414560-1-22-2020-07-CC-DSTN-BL6358-20200124165616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434414560
Report Date: 01/22/2020
Date Signed: 01/22/2020 03:03:28 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
11/06/2019 and conducted by Evaluator Melvin S Matos

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20191106163522

FACILITY NAME:	CHAMPIONS AT ORCHARD ELEMENTARY SCHOOL		FACILITY NUMBER:	434414560
ADMINISTRATOR:	RUBY ALTER		FACILITY TYPE:	840
ADDRESS:	921 FOX LANE		TELEPHONE:	(408) 944-0397
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95131
CAPACITY:	60	CENSUS: 39	DATE:	01/22/2020
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Lisa Bennett		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Staff failed to prevent inappropriate interactions between day care children

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mel Matos met with Lisa Bennett, director, for an unannounced complaint investigation inspection. Purpose of today's inspection: deliver investigation findings.

LPA interviewed the director, two teachers, school age child, and a random sampling of parents for this investigation. In concluding the investigation, LPA Matos concludes that although the allegation noted on this complaint (Staff failed to prevent inappropriate interactions between day care children), 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 thus 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: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

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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