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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434403868
Report Date: 12/20/2023
Date Signed: 03/20/2024 11:42:55 AM

Unsubstantiated


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
08/29/2023 and conducted by Evaluator Teodoro Trujillo
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230829103148
FACILITY NAME:GUTIERREZ, ANAFACILITY NUMBER:
434403868
ADMINISTRATOR:GUTIERREZ, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 363-9648
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY:14CENSUS: DATE:
12/20/2023
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:An GutierrezTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child sustained unexplained bruising while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an Amended Report, this report now supersedes prior LIC9099 dated 12/20/23.

Licensing Program Analyst (LPA) Teodoro Trujillo met with licensee Ana Gutierrez. LPA explained to Ana the purpose of today's visit is: Deliver the investigation findings on the above-mentioned allegation. LPA observed that Licensee and her helper Luz were providing care to 10 children today, including three infants and seven preschool age children.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No Deficiencies were cited during today's visit.

A NOTICE OF SITE VISIT WAS PRINTED AND HANDED TO THE LICENSEE, MUST BE POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
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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