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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416162
Report Date: 07/07/2022
Date Signed: 07/07/2022 10:04:30 AM

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
05/04/2022 and conducted by Evaluator Ofelia Calivo
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220504083823
FACILITY NAME:HACIENDA HI-FIVE AFTER SCHOOL CLUBFACILITY NUMBER:
434416162
ADMINISTRATOR:JULIANNA SILVAFACILITY TYPE:
840
ADDRESS:1290 KIMBERLY DRIVETELEPHONE:
(408) 568-3674
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:60CENSUS: 45DATE:
07/07/2022
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Julianna SilvaTIME COMPLETED:
10:10 AM
ALLEGATION(S):
1
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9
Daycare child sustained broken elbow while in care
Daycare children bullying other daycare children
Staff would not allow daycare child to have second snack
Unqualified staff caring for daycare children
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
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12
13
Licensing Program Analyst (LPA) Ofelia Calivo conducted an unannounced complaint inspection investigation and met with Julianna Silva, Director. Purpose of today’s inspection: deliver investigation findings.

Based on observations and interviews conducted, it is determined that although the allegations noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED.

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: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
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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