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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434412779
Report Date: 10/20/2022
Date Signed: 10/20/2022 04:03:24 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
08/02/2022 and conducted by Evaluator Fermin Campos-Jaramillo
COMPLAINT CONTROL NUMBER: 07-CC-20220802114022
FACILITY NAME:GONZALEZ, ARCELIAFACILITY NUMBER:
434412779
ADMINISTRATOR:GONZALEZ, ARCELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 310-0239
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 2DATE:
10/20/2022
UNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Elena BarbaTIME COMPLETED:
04:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not treat day care child with respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met with Elena Barba, Licensee's helper and sister. Elena stated that licensee Arcelia was not present. LPA explained to Elena the purpose of today's visit is: Deliver the investigation findings on the above-mentioned allegation. LPA observed that Elena was providing care to two infants.
This Department has interviewed the licensee and her helper Elena. LPA has interviewed over the phone some children’s parents, and has also interviewed some minor children.
Based on the available evidence, it is concluded that although the allegations listed on this complaint may have happened, or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegation is therefore UNSUBSTANTIATED.

No deficiencies are cited today.
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: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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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