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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416239
Report Date: 12/05/2022
Date Signed: 12/05/2022 02:32:59 PM

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
09/14/2022 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220914132323
FACILITY NAME:SAFARI KID - EVERGREEN FOWLERFACILITY NUMBER:
434416239
ADMINISTRATOR:PALLAVI SATPATHYFACILITY TYPE:
850
ADDRESS:3122 FOWLER ROADTELEPHONE:
(408) 600-6031
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY:60CENSUS: DATE:
12/05/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Pallavi SatpathyTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff are not providing adequate supervision to day care children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mel Matos conducted an unannounced follow-up complaint investigation and met with Pallavi Satpathy, director. Purpose of today's follow up complaint investigation: deliver investigation findings. The investigation of the complaint allegation listed above was conducted by LPA Matos. Based on interviews, record reviews, observations, and evidence gathered during the investigation process, it is concluded that although the allegation noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

A Notice of Site Visit was provided to Director, Pallavi Satpathy, and must remain posted for 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: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
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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