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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434408035
Report Date: 12/12/2023
Date Signed: 12/12/2023 03:21:16 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2023 and conducted by Evaluator Melanie Otsuji
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20231012105634
FACILITY NAME:AMES CHILD CARE CENTERFACILITY NUMBER:
434408035
ADMINISTRATOR:LAM, HENRYFACILITY TYPE:
850
ADDRESS:BLDG 270 R.T. JONES ROADTELEPHONE:
(650) 604-5100
CITY:MOFFETT FIELDSTATE: CAZIP CODE:
94035
CAPACITY:75CENSUS: 40DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Thao "Kryssie" NguyenTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Staff smoking on the premises.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conclude investigation into the above allegation. LPA was met by Acting Director, Thao "Kryssie" Nguyen. Also present today were 8 additional staff members and 40 preschool aged children.

Interviews conducted stated that although there was a smell of a smoked substance within a classroom, witnesses have never seen anyone smoking in or on the premises. Based on interviews conducted although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED.
A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed. An exit interview was conducted.

An exit interview was conducted with Acting Director, Kryssie Nguyen.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2023
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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