<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416683
Report Date: 10/12/2021
Date Signed: 10/12/2021 05:08:44 PM

Substantiated


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
08/13/2021 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210813094303
FACILITY NAME:ONE WORLDFACILITY NUMBER:
434416683
ADMINISTRATOR:ANNA SIFUENTESFACILITY TYPE:
850
ADDRESS:8387 WREN AVENUETELEPHONE:
(408) 842-4148
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:38CENSUS: 18DATE:
10/12/2021
UNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Anna SifuentesTIME COMPLETED:
12:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not requiring children to wear mask.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced subsequent complaint investigation for the above allegation. LPA met with Licensee Anna Sifuentes and explained the reason for the inspection. Present during today's inspection were Licensee, 3 staff, and 18 children.

Upon arrival of today's inspection, children were going down for a nap; therefore, children were not wearing mask. During the course of this investigation, LPA interviewed staff and third party. Licensee stated that she does not require children to wear a mask, but allows parent to make the decision if their child will wear a mask. LPA also reviewed facility's Mandatory COVID Safety Protocol dated 06/22/2021, which states that children

-------------------CONTINUES ON 9099 DATED 10/12/2021 PAGE 2----------------------------
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
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 3
Control Number 07-CC-20210813094303
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: ONE WORLD
FACILITY NUMBER: 434416683
VISIT DATE: 10/12/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
----------------CONTINUATION OF 9099 DATED 10/12/2021 PAGE 1----------------------------

are encouraged to wear a mask. Based on the information obtained, the above allegation was found to substantiated, meaning the preponderance of the evidence standard has been met.

LPA discussed with Licensee Anna on 08/19/2021 the guidance for child care center, which states that face covering is required for children 2 and older. LPA referred Licensee to PIN 21-18 for the updated guidance. Licensee stated that she will update Mandatory COVID Safety Protocol and send updates to parents; along as to Licensing by 10/19/2021.

As a result of investigation, a Type B citation has been cited. An exit interview was conducted where this report, citation, plan of correction, and appeal rights were discussed and provided to Licensee Anna Sifuentes.

A Notice of Site Visit has been issued and must be posted for 30 consecutive days.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 07-CC-20210813094303
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: ONE WORLD
FACILITY NUMBER: 434416683
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/19/2021
Section Cited
CCR
101223(a)(1)
1
2
3
4
5
6
7
Personal Rights.
The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement is not met as evident by:
1
2
3
4
5
6
7
By POC 10/19/2021, Licensee stated that she will submit a updated Mandatory COVID Safety Protocols to parents and Licensing. Licensee will also include how she provide update to parents.
8
9
10
11
12
13
14
Based on record review and interview, Licensee stated that she does not require children to wear mask, but allows the parents to decide whether their child will wear a mask. This poses a potential risk to the health and safety to the children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3