434414750-9-30-2026-07-CC-GKUN-DZ9PU8-20261027113706

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434414750
Report Date: 09/30/2026
Date Signed: 09/30/2026 03:12:45 PM

Substantiated

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
09/28/2026 and conducted by Evaluator Darnella Barnes

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20260928142150

FACILITY NAME:	SSD STATE PRESCHOOL-LAKEWOOD		FACILITY NUMBER:	434414750
ADMINISTRATOR:	KIM ANH LE		FACILITY TYPE:	850
ADDRESS:	750 Lakechime DR		TELEPHONE:	(408) 522-8213
CITY:	Sunnyvale	STATE: CA	ZIP CODE:	94089
CAPACITY:	48	CENSUS: 19	DATE:	09/30/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	LIndsay Jaconson		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee is operating beyond the scope of their license.

INVESTIGATION FINDINGS:

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On September 30, 2026, Licensing Program Analyst (LPA) Darnella Aulani conducted an unannounced complaint investigation at the facility regarding the allegation that the licensee is operating beyond the scope of their license. The purpose of the visit was explained to Program Manager Lindsay Jacobson, who granted access. At the time of the visit, the Program Director, Site Supervisor Kim Anh Le, Preschool Administrative Assistant, two teachers, two aides, and nineteen children were present.

LPA Aulani toured the facility, observed staff and children, interviewed staff, reviewed records, and obtained documentation related to the allegation listed above.

It was alleged that the licensee is operating beyond the scope of their license. The facility is licensed to serve children ages 3–5 years old; however, it was reported that the program currently has two year old

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Substantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026

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 3

Control Number 07-CC-20260928142150

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: SSD STATE PRESCHOOL-LAKEWOOD	FACILITY NUMBER: 434414750
	VISIT DATE: 09/30/2026

NARRATIVE

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children enrolled and attending. During the investigation, Program Director, Site Supervisor, and Preschool Administrative Assistant stated that there are two year old children attending the program. LPA reviewed enrollment documentation that verified the dates of birth for C1 and C2, confirming that both children were under three years old at the time of enrollment and attendance.

Based on LPAs observations, record reviews, and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

A type “B” deficiency is issued on attached LIC 9099-D. Appeal rights provided. A notice of site visit was given and must remain posted for 30 days.

Report was reviewed with Program Director Lindsay Jacobson,

----END OF REPORT----

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 07-CC-20260928142150

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: SSD STATE PRESCHOOL-LAKEWOOD	FACILITY NUMBER: 434414750
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/30/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/30/2026 Section Cited CCR 101161(a)	1 2 3 4 5 6 7	LIMITATIONS ON CAPACTIY (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.	1 2 3 4 5 6 7	Program Director shall apply for an Exception to care for two-year-old children (C1 and C2) and shall submit a license update to include a starting age of two years by the due date to LPA.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Licensee is operating beyond the scope of their license; children were under three years old at the time of enrollment and attendance. And if not corrected, will create a direct and immediate risk to the health, safety, or personal rights of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026

LIC9099 (FAS) - (06/04)

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