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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416762
Report Date: 10/04/2023
Date Signed: 10/04/2023 08:30:11 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
07/28/2023 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230728163358
FACILITY NAME:ORTEGA, ANA KARINAFACILITY NUMBER:
434416762
ADMINISTRATOR:ORTEGA, ANA KARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 843-8923
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 11DATE:
10/04/2023
UNANNOUNCEDTIME BEGAN:
03:16 PM
MET WITH:Ana Karina OrtegaTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Licensee told disrespectful words to a child in care
Licensee mistreated a child while in care.
Licensee banned a child to participate in a party in the day care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation. LPA met with Licensee Ana Karina Ortega and explained the reason for the inspection.

During today's inspection, LPA conducted observation and interviewed Licensee, assistants, and children. Based on the information obtained, the above allegations are found to be UNSUBSTANTIATED, although, the above allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Exit interview conducted and report was reviewed with Licensee Ana Karina Ortega. 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: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023
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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