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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415594
Report Date: 03/27/2024
Date Signed: 03/27/2024 12:11:12 PM

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
01/03/2024 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240103114812
FACILITY NAME:PRECIOUS MOMENTS PRESCHOOL LLCFACILITY NUMBER:
434415594
ADMINISTRATOR:THUONG LEFACILITY TYPE:
850
ADDRESS:830 WEST EVELYN AVENUETELEPHONE:
(408) 685-2261
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:30CENSUS: 26DATE:
03/27/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Priyanka BansalTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Staff left day care children unattended
Facility has pests
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mel Matos met with Priyanka Bansal, Licensee Representative, for a follow up complaint investigation to deliver investigation findings. Based on interviews, observations, and evidence gathered during the investigation process, the Department concludes that staff did leave day care children unattended in the Orange Room on December 12, 2023 and that the Facility did have ants in the kitchen area of the Facility back in early January 2024. The Facility has remedied the situation and no longer has ants in the kitchen area. The allegations noted above are thus found to be SUBSTANTIATED, meaning the allegations are valid because the preponderance of the evidence standard has been met.
Two "Type B" deficiencies are being cited on the attached LIC 9099-D. Exit interview conducted and report was reviewed with the Licensee representative, Priyanka Bansal. Appeal rights was also provided to Priyanka prior to conclusion of today's inspection.
Notice of site visit was issued and must remain posted for 30 days
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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 3
Control Number 07-CC-20240103114812
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: PRECIOUS MOMENTS PRESCHOOL LLC
FACILITY NUMBER: 434415594
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2024
Section Cited
CCR
101229(a)(1)
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Respsonsibility for Providing Care & Supervision: 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.
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Priyanka Bansal, Licensee Representative, agreed to submit a written Plan of Correction outlining the Facility protocol to ensure that children are supervised at all times by Friday March 29, 2024.
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This requirement was not met as evidenced by: staff did leave day care children unattended in the Orange Room on December 12, 2023. This presents a potential risk to the health, safety, or personal rights of children in care.
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Type B
03/29/2024
Section Cited
CCR
101238(a)(1)
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Buildings & Grounds: The licensee shall take measures to keep the center free of flies, other insects, and rodents. This requirement was not met as evidenced by:
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Priyanka Bansal, Licensee Representative, agreed to submit a written Plan of Correction outlining the measures that the Facility has taken to keep the Facility free of insects by Friday March 29, 2024.
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Facility did have ants in the kitchen area of the Facility back in early January 2024. This presents a potential risk to the health, safety, or 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: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
01/03/2024 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240103114812

FACILITY NAME:PRECIOUS MOMENTS PRESCHOOL LLCFACILITY NUMBER:
434415594
ADMINISTRATOR:THUONG LEFACILITY TYPE:
850
ADDRESS:830 WEST EVELYN AVENUETELEPHONE:
(408) 685-2261
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:30CENSUS: 26DATE:
03/27/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Priyanka BansalTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
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3
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5
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7
8
9
Staff are not providing adequate food service to day care children

Children's bathroom toilets are not clean
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mel Matos conducted an unannounced follow-up complaint investigation and met with Priyanka Bansal, Licensee Representative. Purpose of today's follow up complaint investigation: deliver investigation findings. Based on interviews, record reviews, observations, and evidence gathered during the investigation process, it is concluded that although the allegations noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegations are UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with the Licensee Representative, Priyanka Bansal. No deficiencies issued. A notice of site visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3