434415496-4-11-2022-07-CC-DSTN-CDFLNW-20220413085459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434415496
Report Date: 04/11/2022
Date Signed: 04/11/2022 11:18:26 AM

Unsubstantiated

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
01/28/2022 and conducted by Evaluator Janette Cruz

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20220128084205

FACILITY NAME:	SJB-KENNEDY CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434415496
ADMINISTRATOR:	JESSICA MEJIA		FACILITY TYPE:	850
ADDRESS:	1602 LUCRETIA AVENUE		TELEPHONE:	(408) 320-1785
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95122
CAPACITY:	60	CENSUS: 32	DATE:	04/11/2022
		UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Rosa Garcia		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff not following protocols to prevent the spread of illness.

Child's authorized representative not informed of exposure to COVID in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA)Janette Cruz, conducted an unannounced follow up complaint investigation and met with Rosa Garcia, director. Purpose of today's follow-up complaint investigation: deliver investigation findings.

The investigation of the complaint allegation listed in this complaint was conducted by LPA Janette Cruz. Based on evidence gathered, including record/document reviews, and interviews completed for the complaint investigation, it is concluded that although the allegation noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The allegation is 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 Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 1