434414560-1-26-2023-07-CC-MSEA-CNGRMP-20230127120903

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434414560
Report Date: 01/26/2023
Date Signed: 01/26/2023 04:12:52 PM

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
11/03/2022 and conducted by Evaluator Melvin S Matos

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20221103125905

FACILITY NAME:	CHAMPIONS AT ORCHARD ELEMENTARY SCHOOL		FACILITY NUMBER:	434414560
ADMINISTRATOR:	LISA BENNETT		FACILITY TYPE:	840
ADDRESS:	921 FOX LANE		TELEPHONE:	(408) 624-0534
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95131
CAPACITY:	60	CENSUS: 46	DATE:	01/26/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Lisa Bennett		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Day care child caused injury to another child in care

Facility not providing a safe environment for day care children

Staff intimidates day care child

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mel Matos conducted an unannounced follow-up complaint investigation and met with Lisa Bennett, director. Purpose of today's follow up complaint investigation: deliver investigation findings. The investigation of the complaint allegations listed above was conducted by LPA Matos. Based on interviews, record reviews, observations, and evidence gathered during the investigation process, it is concluded that although the allegations noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. The allegation is UNSUBSTANTIATED.

A Notice of Site Visit was provided to Director, Lisa Bennett, 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: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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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