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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416724
Report Date: 05/30/2025
Date Signed: 05/30/2025 09:20:52 AM

Unsubstantiated


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
05/05/2025 and conducted by Evaluator Andy Yang
COMPLAINT CONTROL NUMBER: 07-CC-20250505145727
FACILITY NAME:NISHIMUTA, YOKOFACILITY NUMBER:
434416724
ADMINISTRATOR:YOKO, NISHIMUTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 460-4714
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:14CENSUS: DATE:
05/30/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yoko NishimutaTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Ratio - Provider operating out of ratio.
Personal Rights - Daycare child sustained an unexplained injury while in care.
INVESTIGATION FINDINGS:
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On 5/30/2025, Licensing Program Analysts (LPAs) Andy Yang and Angela Luz conducted an unannounced complaint investigation. LPA met with Licensee, Yoko Nishimuta to deliver the complaint allegations of personal rights – child sustained an unexplained injury while in care, and ratio – provider operating out of ratio. Present for today's inspection were Licensee, (2) staff, and (4) children (2 infants & 2 preschool age). LPA toured the indoor areas of the facility with licensee.

During the investigation, LPA interviewed parents, and the licensee. Despite the allegations that the facility was out of ratio during drop off time in the morning and pick up time in the evening and children sustained an unexplained injury while in care, interviews and observations did not reveal the (2) allegations that were reported on the facility.

***Continue Page 2***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
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 2
Control Number 07-CC-20250505145727
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: NISHIMUTA, YOKO
FACILITY NUMBER: 434416724
VISIT DATE: 05/30/2025
NARRATIVE
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***Page 2***

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiency issued for this allegation. Appeal Rights provided.



A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2