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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416175
Report Date: 03/12/2025
Date Signed: 03/13/2025 05:13:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
12/09/2024 and conducted by Evaluator Syhshyan Yu
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20241209154932
FACILITY NAME:SJB - JAMES LICK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434416175
ADMINISTRATOR:SABRINA FENECHFACILITY TYPE:
850
ADDRESS:57 NORTH WHITE ROADTELEPHONE:
(408) 928-5221
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:38CENSUS: 41DATE:
03/12/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Sabrina FenechTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Neglect/Lack of supervision - Child sustained injury due to unsafe practices
INVESTIGATION FINDINGS:
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On 03/12/2025 at 10:15 am, Licensing Program Analyst (LPA), Shine Yu, and Licensing Program Manager (LPM), Gladys Kuizon, conducted an unannounced complaint visit and met with director Sabrina Fenech, to deliver investigation findings for the above allegation.

The investigation of the above allegation was conducted by the Community Care Licensing Division (CCLD) Investigations Bureau (IB).

It was alleged that due to staff’s neglect, a child (C1) sustained serious injuries.

(continue on page 2)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
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-20241209154932
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SJB - JAMES LICK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434416175
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2025
Section Cited
CCR
101223(a)(2)
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101223(a)(2) To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment to meet his/her needs.

This requirement was not met as evidenced by:
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Licensee will submit Plan of Correction to the Department by POC due date.
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Staff (S1) allowed Child (C1) to work around unsafe furnishings (storage bin) resulting in the bin’s lid falling onto C1’s thumb and C1 sustaining a serious injury. This posed an immediate risk to C1’s health and safety.
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Civil penalties in the amount of $5,000 per Health & Safety Code 1596.99 (f)(1) is being assessed today due to a violation that resulted in a serious injury. See LIC 421D.
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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: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20241209154932
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SJB - JAMES LICK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434416175
VISIT DATE: 03/12/2025
NARRATIVE
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IB conducted interviews and reviewed medical reports. The investigation revealed that on 12/04/2024, staff (S1) was supervising C1 and allowed C1 to assist with putting away gloves in a storage bin when the lid of the bin fell onto C1’s thumb. C1’s parent and 911 was called. C1 required surgery and partial amputation of thumb.

Based on evidence gathered from the investigation, there were no safety measures on the storage bin to prevent the heavy lid from falling. S1 neglected to check whether the lid was held securely before allowing C1 to work around it.

Based on the investigation conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are being cited on the attached LIC 9099D. Civil penalties in the amount of $5,000 per Health & Safety Code 1596.99 (f)(1) is being assessed today due to a violation that resulted in a serious injury. See LIC 421D.

LPA/LPM informed the director Sabrina Fenech to provide a copy of this licensing report dated 03/12/2025 that documents any A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted with director Sabrina Fenech. A notice of site visit was given and must post for 30 days. Appeal Rights provided.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3