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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417059
Report Date: 07/13/2023
Date Signed: 07/14/2023 08:19:22 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 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
06/20/2023 and conducted by Evaluator Anna Morales
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230620133450
FACILITY NAME:KIDANGO CESAR CHAVEZ EARLY LEARNING CENTERFACILITY NUMBER:
434417059
ADMINISTRATOR:JOSEFINA GARCIA MARQUEZFACILITY TYPE:
850
ADDRESS:2000 KAMMERER AVENUETELEPHONE:
(408) 901-8296
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:96CENSUS: 19DATE:
07/13/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Josefina Garcia MarquezTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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1. Staff member caused injuries to daycare child
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Morales and Licensing Program Manager Gladys Kuizon conducted a Subsequent visit to deliver the finding for the above complaint. LPA met with Director Josefina Garcia Marquez.

LPA conducted interviews with Regional Director, staff and other parties involved on June 23,2023 and on July 3, 2023. Staff stated that C1 (Child) pulled S1(Teacher) hair while out in the playground on June 14,2023 approximately between the hours of 10:30-11:30am. In the process of staff intervening and redirecting C1's hand from pulling S1's hair, C1 received injuries to both left and right hand and on both wrists.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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 3
Control Number 07-CC-20230620133450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KIDANGO CESAR CHAVEZ EARLY LEARNING CENTER
FACILITY NUMBER: 434417059
VISIT DATE: 07/13/2023
NARRATIVE
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Staff stated that they did not observe the injury on C1's hand prior to this incident

Based on LPA’s observation, the preponderance of evidence standard has been met. Therefore, the above allegations are SUBSTANTIATED. Deficiencies are being cited today an follow on LIC9099D.

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


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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20230620133450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KIDANGO CESAR CHAVEZ EARLY LEARNING CENTER
FACILITY NUMBER: 434417059
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/27/2023
Section Cited
CCR
101223(a)(3)
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Personal Rights(a)(3)The licensee shall ensure that each child is accorded the following personal rights:To be free from corporal or unusual punishment, infliction of pain, humiliation,... or other actions of a punitive nature...This requirement was not met as evidence by:
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Director stated that will she will submit their Plan of Action by the POC date.
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 Based on interviews, On June 14,2023, C1 pulled S1's hair while out in the playground, and in the process of staff intervening and redirecting C1's hand from pulling S1's hair, C1 received injuries to both left and right hand and on both wrists. This poses a 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: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3