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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415382
Report Date: 11/18/2021
Date Signed: 11/18/2021 12:58:28 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
08/24/2021 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210824113609
FACILITY NAME:TINY TOTS PRESCHOOL AND CHILDCARE CENTERFACILITY NUMBER:
434415382
ADMINISTRATOR:HOIBERG, ELIZABETHFACILITY TYPE:
840
ADDRESS:8985 MONTEREY ROADTELEPHONE:
(408) 204-3832
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 0DATE:
11/18/2021
UNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Elizabeth HoibergTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is using inappropriate discipline
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced subsequent complaint investigation fro the above allegation. LPA met with Director Elizabeth Hoiberg and explained the reason for the inspection.

During the course of this investigation, LPA reviewed Discipline Policies and Procedures. LPA also conducted interviews with staff, children, and third party. Based on the information obtained, the above allegation was found to be UNSUBSTANTIATED, meaning 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.

No deficiencies were cited as a result of this investigation. Exit interview conducted and report was reviewed with Director Elizabeth Hoiberg. A Notice of Site Visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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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