<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434414297
Report Date: 08/08/2024
Date Signed: 08/08/2024 02:21:26 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
05/28/2024 and conducted by Evaluator Liridon Fici
COMPLAINT CONTROL NUMBER: 07-CC-20240528093308
FACILITY NAME:JOHNSON, CHRISTINAFACILITY NUMBER:
434414297
ADMINISTRATOR:JOHNSON, CHRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 413-9272
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 1DATE:
08/08/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Johnson, ChristinaTIME COMPLETED:
02:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Children are being left unsupervised without an adult supervision.
Licensee didn't provide a safe environment.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/8/2024, at 1:50 PM, Licensing Program Analyst (LPA) Doni Fici arrived unannounced to conduct a subsequent complaint investigation visit, and to deliver findings on the above allegations. LPA met and was greeted by Licensee, Johnson, Christina, and explained the purpose of today’s visit.

During the course of the investigation, LPA interviewed six (6) staff members, Reporting party (RP), and a child's authorized representative.

It was alleged that; Children are being left unsupervised without an adult supervision, and Licensee didn't provide a safe environment. Based on interviews conducted, it was confirmed by 2 out of 3 staff members that on May 21, 2024, there was adult supervision present in the home when C1 was dropped off to daycare...

Continue on Lic9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 07-CC-20240528093308
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: JOHNSON, CHRISTINA
FACILITY NUMBER: 434414297
VISIT DATE: 08/08/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
When LPA asked to confirm the types of chairs that are not allowed to use, Licensee stated the chairs that are not allowed for children to use. During my visit on 6/4/24, and 6/28/24, LPA did not observe any rocking chairs in the home.

Based on the information obtained, the above allegations is found to be UNSUBSTANTIATED, meaning although, the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted with Licensee, and a copy of this report reviewed and provided.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2