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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415380
Report Date: 05/31/2022
Date Signed: 06/01/2022 06:47:48 AM

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
05/25/2022 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220525124509
FACILITY NAME:TINY TOTS PRESCHOOL AND CHILDCARE CENTERFACILITY NUMBER:
434415380
ADMINISTRATOR:HOIBERG, ELIZABETHFACILITY TYPE:
850
ADDRESS:8985 MONTEREY ROADTELEPHONE:
(408) 204-3832
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:90CENSUS: 45DATE:
05/31/2022
UNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Elizabeth HoibergTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Lack of supervision
Facility is commingling children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced initial 10 day complaint investigation for above allegations. LPA met with Director Elizabeth Hoiberg and explained the reason for the inspection. Present during today's inspection were 45 children and at least 5 staff. LPA entered the facility at 10:50AM.

During today's inspection, LPA conducted observation and interviewed staff and children. Based on the information obtained during today's inspection, the above allegations are found to be SUBSTANTIATED, meaning the preponderance of the evidence standard has been met.

-----------------------CONTINUES ON 9099 DATED 05/31/2022 PAGE 2--------------------------
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022
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 4
Control Number 07-CC-20220525124509
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: TINY TOTS PRESCHOOL AND CHILDCARE CENTER
FACILITY NUMBER: 434415380
VISIT DATE: 05/31/2022
NARRATIVE
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-----------------------CONTINUATION OF 9099 DATED 05/31/2022 PAGE 1---------------------

LPA observed at 10:55AM observed that there was staff standing by the door of the school-age room. There were children by the gate that separates the preschool yard and the infant yard. There were also children playing on the other side of the playground near the fence. Staff could not visually supervise children were they were standing. LPA also observed at 11:31AM that a child ran towards the gate that separates the preschool yard and the infant yard. There were no staff present at the time. Staff were at the picnic table at the time and could not visually supervise the child. Director stated that she will conduct training with staff about supervision. Director stated that she will send training notes and send list of staff who received training to Licensing.

LPA also conducted interview with third party on 03/05/2022. 8 out of 13 people interviewed stated that children in the infant and preschool program are commingling. Facility is licensed to serve children 2 years old to entry to first grade. Director stated that she understands the age the preschool license can serve.

LPA Yip informed Director Elizabeth Hoiberg that this report dated 05/31/2022 documents two Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of the children in care.

Also, LPA Yip informed Director Elizabeth to provide a copy of this licensing report date 05/31/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the net day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be place in the child’s file for verification.

As a result of this inspection, two Type A citations were issued. A civil penalty of $250 was assessed for repeat violation. Exit interview conducted and report was reviewed with the Director, Elizabeth Hoiberg. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20220525124509
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: TINY TOTS PRESCHOOL AND CHILDCARE CENTER
FACILITY NUMBER: 434415380
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2022
Section Cited
CCR
101229(a)(1)
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The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement is not met as evident by:
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By POC 06/03/2022, Director stated that she will conduct training with staff about supervision. Director stated that she will send training notes and the list of staff that received training.
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Based on observation, LPA observed at 10:55AM and 11:31AM that children were playing by the gate that separates the infant yard and the preschool yard. Staff were around the corner, but could not visual supervise children. LPA also observed at 10:55AM that there were children playing on the other side of the playground near the fence, where staff cannot visually supervise children. This poses a immediate health and safety risk to the children in care.
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Type A
06/01/2022
Section Cited
CCR
101161(a)
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A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement is not met as evident by:
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By POC 06/01/2022, Director stated that she will submit written statement outlining how the facility will ensure that children are not commingled.
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Based on interview, 8 out 13 people stated that the preschool and infant program commingle. Facility is licensed to serve ages 2 to entry to first grade. This poses an immediate risk to the health and safety to the children in care.
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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: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4