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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434404978
Report Date: 12/05/2023
Date Signed: 12/05/2023 03:21:15 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
10/17/2023 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20231017105852
FACILITY NAME:LOS ARROYOS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434404978
ADMINISTRATOR:OKSANA OKSFACILITY TYPE:
850
ADDRESS:885 MORO DRIVETELEPHONE:
(408) 843-9005
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:96CENSUS: 57DATE:
12/05/2023
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Oksana OksTIME COMPLETED:
11:20 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation. LPA met with Site Director Oksana Oks and explained the reason for the inspection.

During the course of this investigation, LPA interviewed children, staff, and third party. Based on the information obtained, the above allegation is found to be UNSUBSTANTIATED, although, the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were issued as a result of this inspection. Exit interview conducted and report was reviewed with Site Director Oksana Oks. A notice of site has been issued and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
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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