434417026-9-22-2023-07-CC-GKUN-CXT24L-20231121160404

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434417026
Report Date: 09/21/2023
Date Signed: 09/22/2023 11:44:46 AM

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
08/28/2023 and conducted by Evaluator Anna Morales

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20230828100838

FACILITY NAME:	PRIMROSE SCHOOL OF CUPERTINO		FACILITY NUMBER:	434417026
ADMINISTRATOR:	MONICA THOMPSON		FACILITY TYPE:	830
ADDRESS:	1002 SOUTH DE ANZA BOULEVARD		TELEPHONE:	(408) 685-7133
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	24	CENSUS: 12	DATE:	09/21/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Monica Thompson/Sima Shah		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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1. Staff are not providing adequate supervision

INVESTIGATION FINDINGS:

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LPA (Licensing Program Analyst) Anna Morales conducted an subsequent complaint visit for the above allegation. LPA met with Executive Director Monica Thompson and Owner Sima Shah.

Based on the information obtained through interviews with Executive Director, Program Director and staff, S1 was not providing adequate supervision. LPA observed a Final warning issued to S1 on 5/17/23(the date of Incident). for sleeping while supervising children during their nap time in the Young Toddler classroom. S1 was the only staff present.
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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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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Control Number 07-CC-20230828100838

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: PRIMROSE SCHOOL OF CUPERTINO	FACILITY NUMBER: 434417026
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/21/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/22/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision(a)(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.	1 2 3 4 5 6 7	Executive Director stated that part of their POC PLAN, Staff will no longer work at the Center, and all staff will be re-trained on supervision of the children. Director stated she will submit the plan by the POC date.
	8 9 10 11 12 13 14	This requirement was not met by: An incident occured on 5/17/23 where S1 fell asleep while supervising children in the Young Toddler Classroom during naptime. No other staff were present,which poses an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14	Director shall post and provide copies of this licensing report, have LIC 9224 signed and kept on file, to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months & copy of the signed acknowledgment form must be kept in each child's file.
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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: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC9099 (FAS) - (06/04)

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Control Number 07-CC-20230828100838

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: PRIMROSE SCHOOL OF CUPERTINO	FACILITY NUMBER: 434417026
	VISIT DATE: 09/21/2023

NARRATIVE

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Based on the information gathered during the investigation, the preponderance of evidence standard has been met. Therefore, the above allegation is SUBSTANTIATED.

Type A deficiency cited, exit interview conducted and copy of this report provided to the facility.

LPA discussed the requirements of AB633 with the Director and provided the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224), the Director understands the requirements.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC9099 (FAS) - (06/04)

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