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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434403765
Report Date: 07/18/2024
Date Signed: 07/18/2024 12:40:50 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
07/17/2024 and conducted by Evaluator Martha Jimenez-Villanueva
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240717132351
FACILITY NAME:TERRAZAS, MARIAFACILITY NUMBER:
434403765
ADMINISTRATOR:TERRAZAS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 972-8173
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 8DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Elizabeth RomeroTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Licensee is not present in the home,
Reporting Requirements/RP stated he did not receive licensing reports
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Martha Jimenez-Villanueva and Deanna Villagrana, conducted an unannounced complaint inspection to the home today. LPAs met with Assistant Elizabeth Romero and Maria Gomez. Present were licensee's two assistants and eight day care children including seven preschoolers and one school age child. Licensee was not present in the home.

While collecting documents for review, LPAs called licensee Maria Terrazas and about the complaint. Licensee stated she was in Las Vegas for an emergency. Licensee provided location of files and roster of children. LPAs review 16 files and observed child 4 is missing LIC9224.

Based on record and interview conducted with Elizabeth Romero and children, the preponderance of evidence standard has beet met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Health and Safety Code 1596.80, are being cited on attached LIC 9099D. LPA's did not observe at the home, licensee stated she is out of town. LPAs observed child 4 is missing LIC 9224 on file.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 4
Control Number 07-CC-20240717132351
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: TERRAZAS, MARIA
FACILITY NUMBER: 434403765
VISIT DATE: 07/18/2024
NARRATIVE
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The following type A and B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

LPAs Martha Jimenez-Villanueva and Deanna Villagrana informed licensee's assistant Elizabeth Romero that this report dated 07/18/2024 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs Martha Jimenez-Villanueva and Deanna Villagrana informed the licensee's assistant Elizabeth Romero to provide a copy of this licensing report dated 07/18/2024 that documents any Type A citation(s) 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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20240717132351
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: TERRAZAS, MARIA
FACILITY NUMBER: 434403765
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2024
Section Cited
HSC
1596.8595
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A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.
This requirement was not met as evidenced by:
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Licensee will submit proof of complete and signed LIC 9224 for Child 4 by the end of business day of 07/19/2024 to SJ Regional office.
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LPAs review 16 files and observed child 4 is missing LIC9224. This poses an immediate risk to the Health, Safety or 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: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 07-CC-20240717132351
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: TERRAZAS, MARIA
FACILITY NUMBER: 434403765
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2024
Section Cited
CCR
102417(a)
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The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
This requirement is not met as evidenced by:
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Licensee will submit a statement stating she understands above regulation and will close facility when she plans on being away from facility more than 80% of the day to CCLD by the end of business day 07/25/2024.
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LPAs did not observe at the home, licensee stated she is out of town, this poses a potential risk Health, Safety Personal Rights risk 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: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4