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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415518
Report Date: 07/28/2021
Date Signed: 07/28/2021 02:41:58 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
06/10/2021 and conducted by Evaluator Janette Cruz
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210610104107
FACILITY NAME:FUENTES CANO, ANAFACILITY NUMBER:
434415518
ADMINISTRATOR:FUENTES CANO, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 981-7161
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:14CENSUS: 13DATE:
07/28/2021
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Ana Fuentes-CanoTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee operating over capacity.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Janette Cruz and Mel Matos conducted an unannounced complaint inspection investigation and met with Ana Fuentes Cano, Licensee. Purpose of today’s inspection: deliver investigation findings. LPAs also observed 13 children ( 3 infants, 4 pre-school and 6 school-age) and one adult assistant in the home during today's complaint investigation.
Based on the available evidence, record reviews and interviews conducted, it is concluded that the Licensee had at least 16 children present in her daycare during the month of May 2021. The preponderance of evidence standard has thus been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12 & Chapter 1), is being cited on the attached LIC 9099-D. Copy of appeal rights provided to Ana Fuentes-Cano, Licensee, prior to conclusion of today’s inspection.
LPAs discussed the requirements of AB633 to Licensee and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Licensee understands the requirements. Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

A Notice of Site Visit is issued and must be posted near the entrance to the home along with a copy of today's report for 30 days.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
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 2
Control Number 07-CC-20210610104107
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: FUENTES CANO, ANA
FACILITY NUMBER: 434415518
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/28/2021
Section Cited
CCR
102416.5(f)
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102416.5(f) Staffing Ratio Capacity
The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children. This requirement is not met as evidenced by:
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Licensee agreed to submit a written plan of correction that states her understanding that she cannot exceed her licensed capacity by POC date 7/30/21.
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Based on the available evidence, record reviews and interviews conducted, it is concluded that the Licensee had at least 16 children present in her daycare during the month of May 2021.
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According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months and copy of signed acknowledgement form must be kept in each child's file. LPAs advised Licensee that an Office Meeting will be scheduled at a later date. Written notification of the office meeting will be sent to Licensee via mail.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC9099 (FAS) - (06/04)
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