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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430756323
Report Date: 10/02/2024
Date Signed: 10/02/2024 11:48:21 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
09/30/2024 and conducted by Evaluator Marilou Monico
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240930115424
FACILITY NAME:DEMOTTA, PHYLLIS & DERRICKFACILITY NUMBER:
430756323
ADMINISTRATOR:DEMOTTA, PHYLLISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 227-7660
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:14CENSUS: 9DATE:
10/02/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Demotta PhyllisTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Provider does not have appropriate required licensing posters posted for parents to view at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced complaint investigation for the above allegation. LPA met with Licensee, Phyllis Demotta, and explained to her the purpose of today's inspection. LPA toured the facility. LPA did not observe the Notification of Parents' Rights posted at the facility. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

As a result of this inspection, deficiency was cited on the following page.

Exit interview conducted and report was reviewed with Licensee, Phyllis Demotta.

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

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
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
Control Number 07-CC-20240930115424
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: DEMOTTA, PHYLLIS & DERRICK
FACILITY NUMBER: 430756323
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2024
Section Cited
CCR
102419(b)
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Parents Rights. The Licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in an accessible area in the family child care home at all times children are in care.
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Licensee posted the Notification of Parents' Rights poster on the board located by the front door visible to parents or the public during the inspection.

Deficiency corrected.
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This requirement is not met as evidenced by:
LPA observed the Parents' Rights Poster is not posted at the facility. This poses a potential risk to the health, safety and personal rights to children in care.
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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: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC9099 (FAS) - (06/04)
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