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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430710455
Report Date: 10/27/2021
Date Signed: 10/27/2021 10:31:46 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
08/26/2021 and conducted by Evaluator Kristal Goodell
COMPLAINT CONTROL NUMBER: 07-CC-20210826103444
FACILITY NAME:DISCOVERY YEARS, THEFACILITY NUMBER:
430710455
ADMINISTRATOR:AMPARO QUINTEROFACILITY TYPE:
830
ADDRESS:1411 PIEDMONT ROADTELEPHONE:
(408) 926-1234
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY:12CENSUS: 5DATE:
10/27/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mireya BernalTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Personal Rights: Staff taped infant's shoes to infant's feet.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Goodell met with staff member Mireya Bernal to deliver complaint investigation regarding the allegation listed above. LPA observed 5 children with two staff in the infant classroom area. All individuals present have obtained fingerprint clearance through Community Care Licensing. It was alleged that infant teacher taped infant's shoes to infant's feet. During the investigation LPA toured facility and conducted observations of staff with children. LPA obtained documents related to the complaint such as photos, reports, parent handbook and child roster (LIC9040). LPA also conducted interviews with reporting party, parents and staff. Through interviews, LPA learned staff observed infant shoes loose therefore applied tape to shoe to prevent shoes from continuing to fall off and cause child an injury. However, LPA also learned and obtained proof that tape moved to child's ankles and caused visible indentations on child's skin which posed a potential risk to child. Therefore, based on documents and interviews the preponderance of evidence has been met and LPA determined personal rights violation occurred. As a result, the allegation is SUBSTANTIATED.

Title 22 deficiency cited on the attached LIC 9099D. This facility evaluation report was reviewed and discussed. A notice of site visit issued and must remain posted for 30 days. Appeal Rights also issued and discussed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kristal Goodell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
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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Control Number 07-CC-20210826103444
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: DISCOVERY YEARS, THE
FACILITY NUMBER: 430710455
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/03/2021
Section Cited
CCR
101223(a)
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Personal Rights. The licensee shall ensure that each child is accorded the following personal rights:
This requirement is not met due to during investigation LPA learned and obtained proof that the tape infant teacher applied to infant's shoe moved to child's ankles and caused visible indentations on child's skin which posed a potential risk to child.
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Through interviews, LPA learned staff observed infant shoes loose therefore applied tape to shoe to prevent shoes from continuing to fall off and cause an injury. LPA provided website for licensing videos which includes Children's personal rights. Director acknowledged requirement and stated an all staff meeting training on children's personal rights is scheduled. Proof of training will be submitted to LPA by POC due date 11/5/21.
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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: Diana Stephenson
LICENSING EVALUATOR NAME: Kristal Goodell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC9099 (FAS) - (06/04)
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