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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434413889
Report Date: 08/11/2021
Date Signed: 08/11/2021 09:48:48 AM

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
06/02/2021 and conducted by Evaluator Janette Cruz
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210602134359
FACILITY NAME:PHAN, JOSHUAFACILITY NUMBER:
434413889
ADMINISTRATOR:PHAN, JOSHUAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 466-7002
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:14CENSUS: 9DATE:
08/11/2021
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Joshua PhanTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child(ren) receiving excessive time-outs in bathroom.

Child(ren) not receiving adequate meals.

Provider did not accommodate for social distancing.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs)Janette Cruz and Mel Matos conducted an unannounced follow up complaint investigation and met with Joshua Phan, Licensee. Purpose of today's follow up complaint investigation: deliver investigation findings.

The investigation of the three allegations listed above were conducted by LPAs Cruz and Matos. Based on the available evidence including observations, record reviews and interviews completed for this complaint investigation, it is concluded that although the allegations noted 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 allegations are thus UNSUBSTANTIATED.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
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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