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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416248
Report Date: 04/08/2022
Date Signed: 04/08/2022 10:31:00 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
08/10/2021 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210810092035
FACILITY NAME:PRIMROSE SCHOOL OF EVERGREENFACILITY NUMBER:
434416248
ADMINISTRATOR:SONALIKA CLARKFACILITY TYPE:
850
ADDRESS:3008 ABORN ROADTELEPHONE:
(408) 440-8215
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY:165CENSUS: 131DATE:
04/08/2022
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sonalika ClarkTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child sustained unexplained injuries while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mel Matos conducted an unannounced complaint investigation and met with Sonalika Clark, director. Purpose of today's inspection: Deliver investigation findings.

The investigation of the above allegation was conducted by Community Care Licensing Division (CCLD) investigator Blake Williams. Based on interviews, record reviews, and evidence gathered during the investigation process, it is concluded that although the allegation noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The allegation is thus UNSUBSTANTIATED.
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: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022
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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