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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416302
Report Date: 07/22/2025
Date Signed: 07/22/2025 01:30:09 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
07/14/2025 and conducted by Evaluator Jennifer Beehler
COMPLAINT CONTROL NUMBER: 07-CC-20250714111101
FACILITY NAME:REHOBOTH PRESCHOOL/DAYCAREFACILITY NUMBER:
434416302
ADMINISTRATOR:DINORA SANCHEZFACILITY TYPE:
850
ADDRESS:3275 WILLIAMS ROADTELEPHONE:
(408) 603-5251
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:38CENSUS: 32DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee - Merat AyalewTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Licensee is not keeping proper records for children in care
Licensee is not keeping proper records for staff employed at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennifer "Jen" Beehler conducted an unannounced Complaint Investigation. Upon arrival, LPA was greeted by the licensee and provided access to the facility. LPA stated the reason for the visit.

On 07/15/2025, LPA opened the initial investigation and conducted interviews, collected relevant documentation and observed the facility. During today's inspection, LPA conducted interviews, reviewed files, and observed the facility. LPA observed that children and staff files were incomplete. Based on the evidence gathered during this investigation, the Agency has determined the above allegations are SUBSTANTIATED meaning the allegation is valid because the preponderance standard has been met.

Due to today's inspection, deficiencies are cited. Exit interview conducted with the Licensee Merat Ayalew, report was reviewed and provided along with appeal rights.

NOTICE OF SITE VISIT PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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 4
Control Number 07-CC-20250714111101
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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2025
Section Cited
CCR
101217(a)
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Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee....

This requirement has not been met as evidenced by:
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Licensee to provide proof of immunization records and physician's reports for files missing documentation. Licensee to provide a written plan on how to address the files of all new employees and how the facility will review current staff files to ensure all files are complete. This proof should be provided to the LPA by the POC due date.
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LPA observed 2 out of 4 staff files missing immunization records and/ or physician's report and TB test or assessment. This poses a potential risk to the health, safety and personal rights of children in care.
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Type B
08/01/2025
Section Cited
CCR
101221(a)
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Child's Record (a) A separate, complete and current record for each child is maintained in the child care center.

This requirement has not been met as evidenced by: 3 out of 4 children's files reviewed were missing immunization records
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Licensee to provide proof of immunization records and physician's reports for files missing required documentation. Licensee to provide a written plan how facility will handle new enrollees so that all new files are completed prior to child's attendance. Licensee to provide proof to LPA by POC due date.
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and a physician's report with TB test or assessment. This poses a potential threat to the health, safety and personal rights of 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: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 07-CC-20250714111101
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: REHOBOTH PRESCHOOL/DAYCARE
FACILITY NUMBER: 434416302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2025
Section Cited
HSC
1596.8595(c)(1)
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(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation.
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Licensee to provide copies of past reports to all parents of children currently enrolled and collect copies of the signed LIC9224 receipt for every date listed. Licensee to provide proof that this has been completed to LPA by POC due date.
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This requirement has not been met as evidenced by: 4 out of 4 children's files were missing 2 or more LIC9224 receipts documenting Type A Citations or an Office visit dated: 07/15/2025, 04/15/2025, 10/17/2024, 08/07/2024, 07/25/2024. This poses a potential risk to the health, safety and personal rights of 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: Gladys Kuizon
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4