434414879-1-24-2024-07-CC-GKUN-D2GR8R-20240215114818

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434414879
Report Date: 01/24/2024
Date Signed: 01/24/2024 02:23:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
12/01/2023 and conducted by Evaluator Anna Morales

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20231201140252

FACILITY NAME:	CABRILLO MONTESSORI SCHOOL INC		FACILITY NUMBER:	434414879
ADMINISTRATOR:	CINDY PHUNG		FACILITY TYPE:	850
ADDRESS:	2495 CABRILLO AVENUE		TELEPHONE:	(408) 263-6330
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	89	CENSUS: 71	DATE:	01/24/2024
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Cindy Phung		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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1. Day care child sustained an unexplained injury while in care due to lack of staff supervision.
2. Staff member handled day care child in a rough manner while in care.
3. Staff did not report an incident involving day care child in care as necessary.
4. Staff member encouraged day care child to withhold information about an incident from their responsible party.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Morales made an unannounced follow-up complaint investigation inspection. LPA met with Center Director, Cindy Phung. The purpose of today's inspection was to deliver the findings for the above allegations.

LPA Morales interviewed staff, parents, and other parties involved, observed the Classrooms, as well as obtained copies of pertinent information. Throughout the investigation process, it was found the above allegations are UNSUBSTANTIATED; A finding that is unsubstantiated means although the allegations may have happened or is valid, the preponderance of evidence does not prove it.

Exit interview conducted and copy of this report was reviewed with the Director Cindy Phung.

NOTICE OF SITE VISIT WAS ISSUED AND WAS INFORMED TO DIRECTOR 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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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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