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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444405736
Report Date: 01/10/2020
Date Signed: 01/15/2020 03:40:12 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
01/14/2020 and conducted by Evaluator Mahvash Behbood
COMPLAINT CONTROL NUMBER: 07-CC-20200114100221
FACILITY NAME:HURLEY, DEBBIEFACILITY NUMBER:
444405736
ADMINISTRATOR:DEBBIE HURLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 724-3066
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 10DATE:
01/10/2020
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Debbie HurleyTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Provider is operating out of ratio
INVESTIGATION FINDINGS:
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A visit conducted by analyst Behbood to investigate the above allegation. Met Debbie, Licensee. Purpose of visit explained. Present also were 10 children (4 infants, 2 preschooler and 2 School age. Her assistant left suddenly last week.
Based on LPAs observations and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations,102416.5(d), is being cited on the attached LIC. 9099D
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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-20200114100221
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: HURLEY, DEBBIE
FACILITY NUMBER: 444405736
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/15/2020
Section Cited
CCR
102416.5(d)
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Staffing Ratio and Capacity-For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home. This requirement was not met
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She has hired a helper, she will start on 01/16/20.
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evidence by: Licensee had 10 children without an assistance
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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.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3