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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430756323
Report Date: 10/28/2024
Date Signed: 10/28/2024 11:11:53 AM

Unsubstantiated


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:
10/28/2024
UNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Phyllis DemottaTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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9
Provider forces day care child to sit on the toilet for extended periods of time
Provider speaks inappropriately to day care child(ren)
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
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Licensing Program Analysts (LPAs) Marilou Monico and Andy Yang conducted an unannounced follow-up complaint investigation and to deliver findings. LPAs met with Licensee, Phyllis Demotta.

Based on interviews, observations, and evidence gathered during the investigation process, the above allegations are found to be UNSUBSTANTIATED, meaning although, the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

As a result of this inspection, there were no deficiencies issued. Exit interview conducted and report was reviewed with Licensee, Phyllis Demotta.

A Notice of Site Visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024
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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