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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434400448
Report Date: 04/18/2024
Date Signed: 05/09/2024 04:11:22 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
03/27/2024 and conducted by Evaluator Anna Morales
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240327142212
FACILITY NAME:MARTINSON CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434400448
ADMINISTRATOR:LIMOS, ROSIEFACILITY TYPE:
850
ADDRESS:1350 HOPE DRIVETELEPHONE:
(408) 988-8296
CITY:SANTA CLARASTATE: CAZIP CODE:
95054
CAPACITY:70CENSUS: 39DATE:
04/18/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Choling Chow TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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1. Staff are operating the facility out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analysts(LPA's) Anna Morales and Andrea Cortez conducted a subsequent visit for the above allegation. LPA's were greeted by Assistant Director Choling Chow.

Based on interviews, observations, and evidence gathered during the investigation process, A Teachers Aide supervised four children without being supervised under a Fully Qualified teacher for approximately 30 minutes on 4/18/24.

The allegation noted above are thus found to be SUBSTANTIATED, meaning the allegations are valid because the preponderance of the evidence standard has been met.
-(LIC9099C)-



Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
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-20240327142212
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: MARTINSON CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434400448
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/02/2024
Section Cited
CCR
101216.2(e)
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Teacher Aide Qualifications and Duties:101216.29:(e)An aide shall work only under the direct supervision of a teacher. This requirement is not met as evidenced by:
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Director will submit a Plan to ensure that an aide works under the direct supervision of a Fully Qualfied Teacher and to remain ratio at all times, by the POC date, 5/2/24.
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Based on observation and interviews, S1(Teacher's aide) supervised four children on 4/18/24,without direct supervision of a fully qualified teacher, which poses a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20240327142212
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: MARTINSON CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434400448
VISIT DATE: 04/18/2024
NARRATIVE
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One "Type B" deficiency is being cited on the attached LIC 9099-D. Exit interview conducted and report was reviewed with the Assistant Director Choling Chow.
Appeal rights was also provided.

NOTICE OF SITE VISIT WAS ISSUED AND ASSISTANT DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE CENTER FOR A PERIOD OF 30 DAYS.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3