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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430701361
Report Date: 11/30/2023
Date Signed: 11/30/2023 10:23:10 AM

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
09/21/2023 and conducted by Evaluator Janette Cruz
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230921122029
FACILITY NAME:ACTION DAY NURSERYFACILITY NUMBER:
430701361
ADMINISTRATOR:BATE, STEPHANIEFACILITY TYPE:
850
ADDRESS:2146 LINCOLN AVENUETELEPHONE:
(408) 266-8952
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:154CENSUS: 114DATE:
11/30/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Zeenah Ali & Jamie FergusonTIME COMPLETED:
09:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has mice.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Janette Cruz met with Zeennah Ali, office assistant and Jamie Ferguson, Regional Director for an unannounced complaint investigation and deliver investigation findings. LPA discussed the complaint allegations with Zeennah and Jamie.

During investigation it was discovered that there had been sightings of rodents by the Farmhouse classrooms 7 & 8 during the month of September 2023, therefore the above allegation is SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

A deficiency is being cited on the attached LIC 9099D form.

Exit interview conducted and report was reviewed with Jamie Ferguson, Regional Director.

A notice of site visit was given and must remain posted for 30 days.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
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 2
Control Number 07-CC-20230921122029
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: ACTION DAY NURSERY
FACILITY NUMBER: 430701361
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/08/2023
Section Cited
CCR
101238(a)(1)
1
2
3
4
5
6
7
101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
(1) The licensee shall take measures to keep the center free of flies, other insects, and rodents.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
On 10/27/23, Licensee provided proof of monthly professional pest control services routinely conducted at the facility. On 11/30/23, Licensee submitted a plan to keep all areas of the facility clean and free of rodents. Deficiency cleared.
8
9
10
11
12
13
14
Based on observation, interviews, and record reviews, Licensee did not comply with the section cited above. During investigation, it was discovered there had been sightings of rodents by the Farmhouse classrooms 7 & 8 during the month of September 2023, which posed a potential health, safety or personal rights risk to persons 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: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2