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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434402379
Report Date: 12/10/2024
Date Signed: 02/07/2025 08:27:41 AM

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
11/12/2024 and conducted by Evaluator Jennifer Beehler
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20241112105429
FACILITY NAME:GORDON, PAMELAFACILITY NUMBER:
434402379
ADMINISTRATOR:GORDON, PAMELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 257-5425
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:14CENSUS: 6DATE:
12/10/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Pamela GordonTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not provide adequate supervision to children in care resulting in a child wandering from the day care home
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an amended report which supercedes the report delivered on 12/10/2024. Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced complaint investigation. Upon arrival, LPA was greeted by the licensee and provided access. LPA stated the reason for the visit was to deliver findings.

Based on information gathered through confidential interviews and observations, it is concluded that the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.

A Type A Citation has been issued today and an immediate civil penalty. LPA informed licensee that this report dated, 01/29/2025 documents one Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the health, safety, or personal rights of children in care. Also, LPA informed the licensee to provide a copy of this licensing report dated (01/29/2025) that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted with licensee, Pamela Gordon, report was reviewed and provided along with appeal rights.

NOTICE OF SITE VISIT WAS PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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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