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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415080
Report Date: 03/18/2022
Date Signed: 03/21/2022 09:05:49 AM



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
01/21/2022 and conducted by Evaluator Aman Sharma
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220121164711
FACILITY NAME:SELIMOVIC, BELMAFACILITY NUMBER:
434415080
ADMINISTRATOR:SELIMOVIC, BELMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 603-8911
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:14CENSUS: 8DATE:
03/18/2022
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Belma SelimovicTIME COMPLETED:
09:45 AM
ALLEGATION(S):
1
2
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5
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7
8
9
Staff not meeting day-care child's needs.

Staff did not report positive COVID cases to parents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts(LPAs) Aman Sharma and Mel Matos conducted an unannounced follow up complaint investigation and met with Belma Selimovic. Purpose of today's follow up complaint investigation: deliver investigation findings.

The investigation of the complaint allegation listed in this complaint was conducted by LPAs Aman Sharma and Mel Matos. Based on the available evidence, including observations of the Facility, and interviews completed for the 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, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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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