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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430701361
Report Date: 10/24/2024
Date Signed: 11/05/2024 06:38:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
09/12/2024 and conducted by Evaluator Liridon Fici
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240912085203
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: 117DATE:
10/24/2024
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Smriti DataTIME COMPLETED:
02:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care children left unattended.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/23/2024, at 11:35 AM, Licensing Program Analyst (LPA) Liridon Fici- Doni arrived unannounced to conduct a subsequent complaint investigation. Upon entry, LPA met and was greeted by Smriti Data, Director.

During the course of the investigation, LPA interviewed five (5) staff, conducted record review, conducted visual observation, and obtained the following documents: Room 10 roster, and children’s emergency contact information.




Continue on Lic9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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-20240912085203
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ACTION DAY NURSERY
FACILITY NUMBER: 430701361
VISIT DATE: 10/24/2024
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
It was alleged that; Day care children were left unattended. Based on interviews, staff stated there are times where children are not being visually supervised, and children are left unattended when staff take kids to the bathroom because of how the bathroom is constructed and built. Staff 3 (S3) mentioned there have been times where staff will turn their backs to the child to help another child in the bathroom. Staff 4 (S4) stated “there has been times where staff would take children to the bathroom and children are left visually unsupervised”. LPA reviewed class roster and observed there are only two (2) main teachers in room 10, and sometimes another staff from room 14 or another substitute comes to help out when staffing in room 10 is low.

Based on interviews, and record review, which was conducted, the preponderance of evidence standard has been met, therefore the above allegation was found to be Substantiated. California Code of Regulations, (Title 22, Division 12, Chapter 1) 102370(d)(1).

The following type A deficiency were cited on the attached page (9099-D). Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted with director, and a copy of this report review and provided along with appeal rights.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20240912085203
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 10/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/31/2024
Section Cited
CCR
101229(a)(1)
1
2
3
4
5
6
7
101229(a)(1) Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision... (1) No child(ren) shall be left without the supervision of a teacher...(1) Supervision shall include visual observation.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Director agreed to conduct supervision training, and to review section 101229(a)(1)- Responsibility for Providing Care and Supervision, and to submit a signed/dated copy of all preschool staff by POC due date.
8
9
10
11
12
13
14
Based on interviews and record review, the licensee did not comply with the section cited above in not visually supervising children while teachers are taking children to the bathroom, which poses a immediate 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: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3