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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416302
Report Date: 07/25/2024
Date Signed: 07/25/2024 07:04:41 PM

Substantiated


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
07/10/2024 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240710171210
FACILITY NAME:REHOBOTH PRESCHOOL/DAYCAREFACILITY NUMBER:
434416302
ADMINISTRATOR:MERAT AYALEWFACILITY TYPE:
850
ADDRESS:3275 WILLIAMS ROADTELEPHONE:
(408) 603-5251
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:38CENSUS: 31DATE:
07/25/2024
UNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Merat AyalewTIME COMPLETED:
05:25 PM
ALLEGATION(S):
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9
Drinking water is not readily available
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigaiton for the above allegation. LPA met with Licensee Merat Ayalew and explained the reason for the inspection.

During the course of this investigation, LPA conducted observation and inspected the physical plant. LPA also interviewed children. Based on the information obtained, the above allegation is found be SUBSTANTIATED, meaning the prepondence standard has been met.

--------------CONTINUES ON 9099 DATED 07/25/2024 PAGE 2----------------
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
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 4
Control Number 07-CC-20240710171210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302
VISIT DATE: 07/25/2024
NARRATIVE
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-------------CONTINUATION OF 9099 DATED 07/25/2024 PAGE 1------------

On 07/25/2024, LPA observed that children were in the outside activity area. Children's water bottles were not brought outside. At 11:09AM, LPA observed that a staff brought a cart with the children's food and water bottles outside.

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Licensee Merat Ayalew. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20240710171210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2024
Section Cited
CCR
101239.2(a)
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Drinking Water. Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area.
This requirement is not met as evidenced by:
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By POC 08/01/2024, faciltiy will submit written plan how they will ensure children have access to water both indoor and outdoors.
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Based on observation, children went outside at 11AM. Their water bottles were brought outside at 11:09AM, which poses a potential health and safety risk to children in care.
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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: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
07/10/2024 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240710171210

FACILITY NAME:REHOBOTH PRESCHOOL/DAYCAREFACILITY NUMBER:
434416302
ADMINISTRATOR:MERAT AYALEWFACILITY TYPE:
850
ADDRESS:3275 WILLIAMS ROADTELEPHONE:
(408) 603-5251
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:38CENSUS: DATE:
07/25/2024
UNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Merat AyalewTIME COMPLETED:
05:25 PM
ALLEGATION(S):
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2
3
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5
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7
8
9
Equipment is not age-appropriate
INVESTIGATION FINDINGS:
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2
3
4
5
6
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8
9
10
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12
13
Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation for the above allegation. LPA met with Licensee Merat Ayalew and explained the reason for the inspection.

During the course of this investigation, LPA conducted observation and inspected the physical plant. Based on the information obtained, the above allegations are found to be UNSUBSTANTIATED, meaning, although, the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No defiencies were issued as a result of this investigation. Exit interview conducted and report was reviewed wtih Licensee Merat Ayalew. A notice of site visit has been issued and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4