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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434400493
Report Date: 07/24/2023
Date Signed: 07/24/2023 02:28:45 PM

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
04/25/2023 and conducted by Evaluator Marilou Monico
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230425093806
FACILITY NAME:KIDANGO VALLEY MEDICAL CENTERFACILITY NUMBER:
434400493
ADMINISTRATOR:GRAY, STACIEFACILITY TYPE:
850
ADDRESS:730 EMPY WAYTELEPHONE:
(408) 429-2683
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:57CENSUS: 36DATE:
07/24/2023
UNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Stacie Gray-WalkerTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child engaged in inappropriate behavior with another day care child while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced complaint inspection to deliver investigation findings. LPA met with Site Director, Stacie Gray-Walker.

The investigation of the above allegation was conducted by Community Care Licensing Division (CCLD) Investigator, Victoria McIntosh. Based on interviews conducted, record reviews, report from the Santa Clara County Sheriff's Office, and evidence gathered during the investigation process, there is no preponderance of evidence that the allegation did or did not occur or due to lack of supervision. The allegation is thus UNSUBSTANTIATED.


A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAY.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
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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