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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416205
Report Date: 02/15/2023
Date Signed: 02/15/2023 02:13:29 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
11/28/2022 and conducted by Evaluator Teodoro Trujillo
COMPLAINT CONTROL NUMBER: 07-CC-20221128150749
FACILITY NAME:SUTACHAN, JEIMYFACILITY NUMBER:
434416205
ADMINISTRATOR:JEIMY SUTACHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 309-2128
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 9DATE:
02/15/2023
UNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Jeimy SutachanTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is operating over capacity
Licensee allows uncleared adults to live in the home
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Teodoro Trujillo conducted a Subsequent visit to deliver the finding for the above allegation. LPA was greeted by Licensee Jeimy Sutachan. Present were her two assistants, Sonia, and Sandra with 9 children, two whom were infant children, seven preschool age children

Complainant alleges that Provider operating over capacity, allows uncleared adults to live in the home. LPA obtained information from the interviews that were conducted with the Licensee, parents, and other parties involved. LPA, also, reviewed supporting documentation, which included the Facility Staff files.

Based on the available evidence, including observations of the Facility, documents reviewed, and interviews completed for the complaint investigation, it is concluded that although the allegation noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.
Exit interview conducted and report was reviewed with the licensee Jeimy.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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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