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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415816
Report Date: 08/11/2023
Date Signed: 08/11/2023 03:41:07 PM

Unsubstantiated


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
04/03/2023 and conducted by Evaluator Janette Cruz
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230403151212
FACILITY NAME:PRABHA, MADHAVIFACILITY NUMBER:
434415816
ADMINISTRATOR:PRABHA, MADHAVIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 239-4049
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:14CENSUS: 9DATE:
08/11/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Madhavi PrabhaTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee restrained child

Licensee did not ensure that child's toileting needs were met

Adult in the home hit child
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Janette Cruz and Jessica Bongardt conducted an unannounced complaint inspection to deliver investigation findings. LPAs met with Madhavi Prabha, Licensee.

The investigation of the above allegation was conducted by LPA Janette Cruz. Based on interviews conducted, record reviews and evidence gathered during the investigation process, there is no preponderance of evidence that the allegations did or did not occur. The allegations are thus UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with Madhavi Prabha, Licensee.

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: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
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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