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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416230
Report Date: 04/11/2024
Date Signed: 04/11/2024 12:47:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
03/13/2024 and conducted by Evaluator Sheena Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240313104721
FACILITY NAME:SJB-FOOTHILL CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434416230
ADMINISTRATOR:ANN-MARIE LEMMERMANFACILITY TYPE:
830
ADDRESS:230 PALA AVENUETELEPHONE:
(408) 928-5223
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:25CENSUS: 15DATE:
04/11/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ann-Marie LemmermanTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not immediately notify child's authorized representative of injury
INVESTIGATION FINDINGS:
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On 4/11/24 around 9:30am Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced complaint inspections and met with the director, Ann-Marie Lemmerman. LPA explained to the director that the purpose of today's inspection was to continue investigations and deliver the investigation finding for the above allegation. The associate program director, Maria Velazquez arrived at the facility around 10:15am.

During investigations, LPA interview staff and review files regarding the incident on 9/27/22. The center did not notify the parents when the injury was in the child’s head area. The center notified the mom about the injury when mom picked up the child. Based on the interviews and records review, the preponderance of evidence standard has been met, therefore the allegation of “Staff did not immediately notify child's authorized representative of injury.“ is found to be SUBSTANTIATED.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
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 4
Control Number 07-CC-20240313104721
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SJB-FOOTHILL CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434416230
VISIT DATE: 04/11/2024
NARRATIVE
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A deficiency is being cited on LIC9099D.
Exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were reviewed and discussed with the director, Ann-Marie Lemmerman.

Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
03/13/2024 and conducted by Evaluator Sheena Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240313104721

FACILITY NAME:SJB-FOOTHILL CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434416230
ADMINISTRATOR:ANN-MARIE LEMMERMANFACILITY TYPE:
830
ADDRESS:230 PALA AVENUETELEPHONE:
(408) 928-5223
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:25CENSUS: 15DATE:
04/11/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ann-Marie LemmermanTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not make prompt arrangements for obtaining medical treatment for child.
INVESTIGATION FINDINGS:
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On 4/11/24 about 9:30am Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced complaint inspections and met with the director, Ann-Marie Lemmerman. LPA explained to the director the purpose of today's inspection, continuing investigations and delivering the investigation finding for the above allegation. The associate program director, Maria Velazquez arrived at the facility about 10:15am.

During investigations, LPA interviewed staff and reviewed files regarding the incident on 9/27/22. The staff had checked the injured children a couple of times on 9/27/22 but didn’t find injuries on the child until around 5pm on 9/27/22. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview was conducted and this report was reviewed and discussed with director Ann-Marie Lemmerman. Notice of site visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 07-CC-20240313104721
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SJB-FOOTHILL CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434416230
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2024
Section Cited
CCR
101226(a)
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101226 (a)The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch...
This requirement was not met as evidenced by :
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Melissa Leza, the program director for SJB stated that notifying authorized representatives immediately when children have injuries in the head area even without signs of injuries will be written in the SJB policy.
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Based on interviews and records review, the licensee did not comply with the regulations above. The center did not notify the parents when the injury was in the child’s head area, which poses an potential Health, Safety and Personal Rights risk to persons in care.
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The associate program director, Maria Velazquez stated that she will send LPA a copy of the updated policy regarding head injuries.
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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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4