434414670-10-20-2021-07-CC-DSTN-C86QW5-20211026123123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434414670
Report Date: 10/20/2021
Date Signed: 10/20/2021 02:52:06 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
08/04/2021 and conducted by Evaluator Ofelia Calivo

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20210804104323

FACILITY NAME:	ACTION DAY PRIMARY PLUS		FACILITY NUMBER:	434414670
ADMINISTRATOR:	SCHROEDER, PAULA		FACILITY TYPE:	830
ADDRESS:	2174 LINCOLN AVENUE		TELEPHONE:	(408) 266-8188
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	50	CENSUS: 34	DATE:	10/20/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Shyla Duarte		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Center did not report COVID-19 positive case.

Center did not notify parents and staff of the COVID-19 positive case.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ofelia Calivo conducted an unannounced follow-up complaint investigation and met with Shyla Duarte, Director. The purpose of today's follow-up complaint investigation: to deliver investigation findings. The investigation into the following allegations: 1) Center did not report COVID-19 positive case. 2) Center did not notify parents and staff of the COVID-19 positive case. Based on observations, record reviews of Staff Roster and Child Care Facility Roster and interviews with Staff 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 ISSUED AND THE DIRECTOR WAS ADVISED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 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: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

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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