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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415729
Report Date: 10/26/2022
Date Signed: 10/26/2022 03:13:20 PM

Unsubstantiated


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
09/13/2022 and conducted by Evaluator Kassandra Medrano
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220913162526
FACILITY NAME:ESTRELLA FAMILY SERVICES @ GARDNERFACILITY NUMBER:
434415729
ADMINISTRATOR:KRISTINE NGUYENFACILITY TYPE:
850
ADDRESS:611 WILLIS AVENUETELEPHONE:
(408) 269-7827
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:80CENSUS: 41DATE:
10/26/2022
UNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Kristine NguyenTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit child in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 26th, 2022 at 1:30pm Licensing Program Analyst (LPA), Kassandra Medrano, conducted an unannounced subsequent complaint inspection to deliver findings of the investigation. LPA met with Director, Kristine Nguyen and explained the nature of today's inspection.

LPA Medrano conducted interviews,toured the facility and obtained copies of pertinent information. Based on information obtained; there is not enough evidence to prove that the above allegation has occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegations did or did not occur. Due to the above information, the allegations are UNSUBSTANTIATED.

NOTICE OF SITE VISIT WAS ISSUED AND SHALL BE POSTED FOR 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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