434416248-4-8-2022-07-CC-DSTN-CDLTVZ-20220418150446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434416248
Report Date: 04/08/2022
Date Signed: 04/08/2022 10:34:33 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
09/07/2021 and conducted by Evaluator Melvin S Matos

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20210907161532

FACILITY NAME:	PRIMROSE SCHOOL OF EVERGREEN		FACILITY NUMBER:	434416248
ADMINISTRATOR:	SONALIKA CLARK		FACILITY TYPE:	850
ADDRESS:	3008 ABORN ROAD		TELEPHONE:	(408) 440-8215
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	165	CENSUS: 131	DATE:	04/08/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Sonalika Clark		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff inappropriately touched child in care
Staff hit child in care
Staff spoke inappropriately to children in care
Staff forced child to nap
Staff did not allow child to use the restroom

INVESTIGATION FINDINGS:

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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 allegations 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 allegations noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegations are 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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