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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416723
Report Date: 12/20/2023
Date Signed: 12/20/2023 04:24:07 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
11/21/2023 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20231121153937
FACILITY NAME:SINGH, POOJAFACILITY NUMBER:
434416723
ADMINISTRATOR:POOJA, SINGHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 442-8503
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 10DATE:
12/20/2023
UNANNOUNCEDTIME BEGAN:
04:01 PM
MET WITH:Pooja SinghTIME COMPLETED:
04:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not ensure adequate care and supervision which caused a child to be injured by other children while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation. LPA met with Licensee Pooja Singh and explained the reason for the inspection.

During the course of this investigation, LPA conducted observation. LPA also interviewed staff, children, and third party. Based on the information obtained, the above allegation is 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 violation did or did not occur.

No deficiencies were issued as a result of this inspection. Exit interview conducted and report was reviewed with Licensee Pooja Singh. 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: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
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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