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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444411318
Report Date: 07/22/2020
Date Signed: 07/22/2020 03:21:11 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
02/26/2020 and conducted by Evaluator Mahvash Behbood
COMPLAINT CONTROL NUMBER: 07-CC-20200226165722
FACILITY NAME:DIAZ, VERONICAFACILITY NUMBER:
444411318
ADMINISTRATOR:DIAZ, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-1815
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 10DATE:
07/22/2020
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Veronica DiazTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child was hit by staff
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
A tele-complaint inspection was conducted via Face Time. The purpose of face call explained, children were interviwed and the finding derlivered verbally.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
This report will be emailed to licensee and she understands that her acknowledment of receiving this report will count as her signature.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2020
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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