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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415566
Report Date: 10/12/2023
Date Signed: 10/19/2023 01:53:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 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
10/11/2023 and conducted by Evaluator Farida Raja
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20231011145440
FACILITY NAME:SJB-W.C. OVERFELT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434415566
ADMINISTRATOR:YESENIA RIVAS BEJARANOFACILITY TYPE:
850
ADDRESS:1835 CUNNINGHAM AVENUETELEPHONE:
(408) 928-5260
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:44CENSUS: 3DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
11:59 AM
MET WITH:Reena Saini and Fabiola ValadezTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Reporting requirements- Facility failed to report change of director
INVESTIGATION FINDINGS:
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On 10/12/2023 at 11:59am, Licensing Program Analyst (LPA), Farida Raja conducted an unannounced initial 10 day complaint visit. LPA met with Director, Reena Saini and Regional Director, Fabiola Valadez, and explained the purpose of today's inspection.

On October 11, 2023, the department recieved a complaint alleging that the facility failed to report change of director. On October 12, 2023, LPA conducted an unannounced initial visit and interviewed Director and Regional Director. LPA conducted facility walkthrough and observed the ratios in each classroom. LPA reviewed director records and obtained copies of relevant information.

Based on interviews with director and regional director, they confirmed that Childcare Licensing (CCL) department was not notified of the change of director and director packet was not submitted for review within the regulatory timeframe.
Continued on Page 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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-20231011145440
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SJB-W.C. OVERFELT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434415566
VISIT DATE: 10/12/2023
NARRATIVE
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Based on LPA observations during site visit, interviews conducted, records reviewed, and evidence gathered during the investigation process, the Department found that the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22 are being cited on the attached LIC 9099D. Appeal Rights provided.

Exit interview was conducted with Regional Director, Fabiola Valadez.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20231011145440
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SJB-W.C. OVERFELT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434415566
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/26/2023
Section Cited
CCR
101212(b)
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101212 Reporting Requirements (b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).
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Regional Manager will submit a complete Director packet to CCL for review and plan of correction by 10/26/2023.
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Based on interview, the facility did not report change of director or submit a completed director packet to Community Care Licensing (CCL) for review within 10 days of a change of director. This poses a potential risk to the health, safety, and personal rights of 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: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3