434415382-5-17-2019-07-CC-ASTR-BCERSU-20190522131719

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434415382
Report Date: 05/16/2019
Date Signed: 05/17/2019 09:04:42 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
05/10/2019 and conducted by Evaluator Samantha Yip

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20190510120057

FACILITY NAME:	TINY TOTS PRESCHOOL AND CHILDCARE CENTER		FACILITY NUMBER:	434415382
ADMINISTRATOR:	HOIBERG, ELIZABETH		FACILITY TYPE:	840
ADDRESS:	8985 MONTEREY ROAD		TELEPHONE:	(408) 710-3338
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 11	DATE:	05/16/2019
		UNANNOUNCED	TIME BEGAN:	02:55 PM
MET WITH:	Elizabeth Hoiberg		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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9

Lack of supervision resulting in child sustaining injury.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced initial 10 day complaint for the above allegation. LPA met with Director Elizabeth Hoiberg and explained the reason for the investigation.

During the investigation, LPA interviewed staff and children. Based on the information obtained, although, the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Director Elizabeth, where this report was discussed. Notice of Site was issued and must be posted for 30 consecutive days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019

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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