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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 274412287
Report Date: 01/31/2023
Date Signed: 01/31/2023 01:50:39 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
11/08/2022 and conducted by Evaluator Susy Cervantes
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20221108162422
FACILITY NAME:CASTILLO-URENA, ADRIANNAFACILITY NUMBER:
274412287
ADMINISTRATOR:CASTILLO-URENA, ADRIANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 578-9340
CITY:SOLEDADSTATE: CAZIP CODE:
93960
CAPACITY:14CENSUS: 8DATE:
01/31/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Adriana UrenaTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Provider caused bruising to day care child
Provider hit day care child(ren)
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 01/31/2023 at 01:15 PM, Licensing Program Analysts (LPAs) Susy Cervantes and Cynthia Tamaypo, met with licensee, Adriana Urena, for a complaint investigation. Present was licensee and their 14 year old assistant/daughter with 8 children in care: 2 infants and 6 preschool.

LPAs conducted interviews during today's visit. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with licensee, Adriana Urena.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023
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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