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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416304
Report Date: 08/18/2025
Date Signed: 08/18/2025 10:11:57 AM

Unsubstantiated


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
07/16/2025 and conducted by Evaluator Jennifer Beehler
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20250716201441
FACILITY NAME:REHOBOTH PRESCHOOL/DAYCAREFACILITY NUMBER:
434416304
ADMINISTRATOR:DINORA SANCHEZFACILITY TYPE:
840
ADDRESS:3275 WILLIAMS ROADTELEPHONE:
(408) 603-5251
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:38CENSUS: 6DATE:
08/18/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee - Merat AyalewTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Personal Rights - Licensee fed a child in the bathroom.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennifer “Jen” Beehler conducted an unannounced Complaint Investigation. Upon arrival, LPA was greeted by the licensee and provided access to the facility. LPA stated the reason for the visit was to deliver findings.

During this investigation, LPA conducted inspections on 07/22/2025, 07/31/2025 and 08/18/2025. LPA conducted interviews, observed the facility and collected relevant documentation. Reporting Party (RP) alleged that licensee was observed feeding a child in the bathroom. RP was unable to identify the child.

Based on evidence gathered, this allegation is UNSUBSTANTIATED, meaning, although, the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No defiencies were issued as a result of this investigation. Exit interview conducted and report was reviewed wtih Licensee Merat Ayalew. A notice of site visit has been issued and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
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
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
07/16/2025 and conducted by Evaluator Jennifer Beehler
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20250716201441

FACILITY NAME:REHOBOTH PRESCHOOL/DAYCAREFACILITY NUMBER:
434416304
ADMINISTRATOR:DINORA SANCHEZFACILITY TYPE:
840
ADDRESS:3275 WILLIAMS ROADTELEPHONE:
(408) 603-5251
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:38CENSUS: 25DATE:
08/18/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee - Merat AyalewTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Qualifications - Licensee allows staff to work without required documentation
Criminal Record Clearance - Licensee allows to work without proper criminal record clearance
INVESTIGATION FINDINGS:
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On 08/18/2025, Licensing Program Analyst (LPA) Jennifer “Jen” Beehler conducted an unannounced Complaint Investigation. Upon arrival, LPA was greeted by the licensee and provided access to the facility. LPA stated the reason for the visit was to deliver findings.

During this investigation, LPA conducted inspections on 07/22/2025, 07/31/2025 and 08/13/2025. LPA conducted interviews, observed the facility and collected relevant documentation. Facility did not have files available for S1, S2 and S3 during the inspection process. S1 does not have criminal record clearance.

Due to today's investigation, deficiencies are cited. More details provided on the attached LIC9099-D. Exit interview conducted with Licensee Merat Ayalew, report was reviewed and provided along with appeal rights.

NOTICE OF SITE VISIT WAS PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20250716201441
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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416304
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/20/2025
Section Cited
CCR
101170(e)(1)
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101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department
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Licensee to remove S1 from the staff until he is Criminal Record Cleared. Licensee to submit a written letter to the Department by POC due date outlining the steps taken to insure all staff are Criminal Record Cleared prior to working at the facility.
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This requirement has not been met as evidenced by: Based on witness testimony S1 has been providing transportation to children in care and does not have criminal record clearance. This poses an immediate risk to the health, safety and personal rights of children in care.
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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: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 07-CC-20250716201441
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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416304
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2025
Section Cited
CCR
101217(a)
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101217 Personnel Records (a)The licensee shall ensure that personnel records are maintained...Each personnel record shall contain the following information: (1)Employee's full name.(2) Driver's license number if the employee is to transport children....
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Licensee to complete all Personnel Files for any staff prior to placing them on the facility schedule. Licensee to remove staff from the schedule until all documentation is collected. Licensee to submit a letter to the Department outlining the facility process for hiring staff to ensure the facility's records are always in compliance.
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This requirement has not been met as evidenced by: S1, S2 and S3 did not have Personnel Files when requested by the Department. This poses a potential risk to the health and safety of children in care.
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Licensee to email letter to LPA by POC due date.
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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: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4