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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434409500
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:50:16 PM

Substantiated


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
08/23/2022 and conducted by Evaluator Melvin S Matos
COMPLAINT CONTROL NUMBER: 07-CC-20220823111005
FACILITY NAME:MORENO VEGA, NORMAFACILITY NUMBER:
434409500
ADMINISTRATOR:MORENO VEGA, NORMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 835-6694
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY:14CENSUS: 7DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Norma Moreno VegaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Provider is operating over capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mel Matos met with Norma Moreno Vega, Licensee, for a follow up complaint investigation. Purpose of today's investigation: deliver complaint investigation findings. LPA also observed seven day care children (3 infants & 4 preschool) and one adult assistant (Cristina Rojas Oseguera) in the home during today's investigation. The investigation of the complaint allegation listed above was conducted by LPA Matos.
Based on interviews, record reviews, observations, and evidence gathered during the investigation process, the Department concludes that the Licensee had 17 children present in her day care on July 1, 8, & 15, 2022 and 15 children present on July 22 & 29, 2022. It is thus concluded that the above allegation is found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met. A "Type A" deficiency is being cited on the attached LIC 9099-D. Exit interview conducted and report/appeal rights reviewed with Licensee, Norma Moreno Vega. A notice of site visit was given and must remain posted along with today's report for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
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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Control Number 07-CC-20220823111005
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MORENO VEGA, NORMA
FACILITY NUMBER: 434409500
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/18/2022
Section Cited
CCR
102416.5(f)
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Staffing Ratio and Capacity: The total licensed capacity for a large Family Child Care Home shall not exceed fourteen children. This requirement was not met as evidenced by: Based on interviews,
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Licensee agreed to submit a written Plan of Correction which states her understanding that she cannot exceed her licensed capacity. Plan must also include the name, ages, and schedules of all children enrolled.
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record reviews, observations, and evidence gathered, it is concluded that the Licensee had 17 children present in her day care on July 1, 8, & 15, 2022 & 15 children present on July 22 & 29, 2022.
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According to AB 633, parents must be provided with a copy of this report which contains this Type A deficiency for the next 12 months and a copy of signed acknowledgement form (LIC 9224) must be kept in each child's file.
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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: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2