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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415535
Report Date: 10/15/2020
Date Signed: 10/15/2020 03:25:12 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
08/06/2020 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20200806104711
FACILITY NAME:BANUELOS, YADIRAFACILITY NUMBER:
434415535
ADMINISTRATOR:YADIRA BANUELOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 286-8714
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 9DATE:
10/15/2020
ANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Yadira BanuelosTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
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9
Day care children are excessively crying and screaming due to lack of adequate care and supervision
INVESTIGATION FINDINGS:
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10
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Licensing Program Analyst (LPA) Mel Matos conducted an announced tele-investigation via FaceTime with Yadira Banuelos, Licensee. Purpose of today's tele-inspection: deliver investigation findings. The Licensee's adult assistant and nine day care children were also present in the home.
The investigation into the following allegation: 1) Day care children are excessively crying and screaming due to lack of adequate care and supervision was conducted by LPA Mel Matos. Based on the available evidence 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 AND THE LICENSEE WAS ADVISED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020
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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