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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430709377
Report Date: 07/24/2024
Date Signed: 07/24/2024 04:08:03 PM

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
05/31/2024 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240531162910
FACILITY NAME:PRIMARY PLUSFACILITY NUMBER:
430709377
ADMINISTRATOR:GUZMAN, SHUREEFACILITY TYPE:
850
ADDRESS:18720 BUCKNALL ROADTELEPHONE:
(408) 370-0357
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:278CENSUS: 114DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Shuree GuzmanTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility is out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation for the above allegations. LPA met with Director Shuree Guzman and explained the reason for the inspection.

During the course of this investigation, LPA conducted observation. LPA also interviewed staff, children, and parents. LPA also reviewed sign in/out, class rosters, and staff files. Based on the information obtained, the above allegation is found be SUBSTANTIATED, meaning meaning the preponderance of the evidence standard has been met.
---------------CONTINUES ON 9099 DATED 07/24/2024 PAGE 2------------------
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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 4
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
05/31/2024 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240531162910

FACILITY NAME:PRIMARY PLUSFACILITY NUMBER:
430709377
ADMINISTRATOR:GUZMAN, SHUREEFACILITY TYPE:
850
ADDRESS:18720 BUCKNALL ROADTELEPHONE:
(408) 370-0357
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:278CENSUS: 114DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Shuree GuzmanTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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3
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8
9
Daycare is malodorous.
Staff did not notify child's authorized representative of incident.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation for the above allegations. LPA met with Director Shuree Guzman and explained the reason for the inspection.

During the course of this investigation, LPA reviewed incident reports. LPA also inspected the physical plant and interviewed staff, children, and parents. Based on the information obtained, the above allegations is found to be UNSUBSTANTIATED, meaning although, the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were issued as a result of this investigation. Exit interview conducted and report was reviewed with Director Shuree Guzman. A notice of site visit has been issued and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20240531162910
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: PRIMARY PLUS
FACILITY NUMBER: 430709377
VISIT DATE: 07/24/2024
NARRATIVE
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------------CONTINUATION OF 9099 DATED 07/24/2024 PAGE 1---------------

On 06/04/2024, LPA observed that S-1 was present during inspection and was the only staff present in the room. S-1 completed 10 semester units. LPA discussed with Director that the preventive health and safety course does not count as one of the course to be a fully qualified teacher. Director stated that S-1 is not longer employed at the center.

As a result of this inspection, a Type B citations was issued. Exit interview conducted and report was reviewed with Director Shuree Guzman. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 07-CC-20240531162910
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: PRIMARY PLUS
FACILITY NUMBER: 430709377
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2024
Section Cited
CCR
101216.1(c)(1)(A)
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Teacher Qualifications and Duties. The units specified in (c)(1) above shall include courses that cover the general areas of child growth and development, or human growth and development; child, family and community, or child and family; and program/curriculum.
This requirement is not met as evidenced by:
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By POC 07/24/2024, Director will submit written statement that she understands the teacher qualification.
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Based on record review, S-1 completed 10 semester units. S-1 was left alone with the children, which poses a potential health and safety risk to children in care.
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S-1 is not longer employed at the center.
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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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4