434417071-6-6-2024-07-CC-BDEL-D6G6H5-20240621204857

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434417071
Report Date: 06/06/2024
Date Signed: 06/06/2024 11:40:26 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
03/13/2024 and conducted by Evaluator Melvin S Matos

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20240313143506

FACILITY NAME:	LUCCIOLA ACADEMY		FACILITY NUMBER:	434417071
ADMINISTRATOR:	NOPPAKET PONGCHANA		FACILITY TYPE:	850
ADDRESS:	1711 HAMILTON AVENUE		TELEPHONE:	(408) 300-1646
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	104	CENSUS: 27	DATE:	06/06/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Noppaket Pongchana		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff do not provide food in the quantity necessary to meet the needs of the child

Lack of supervision resulting in child sustaining unexplained bruises

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mel Matos met with Noppaket Pongchana, Licensee representative/Director, for a follow up complaint investigation to deliver investigation findings. Based on interviews, observations, record reviews, and evidence gathered during the investigation process, it is concluded that although the allegations noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with the Licensee representative/Director, Noppaket Pongchana. No deficiencies issued. A notice of site visit was given and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

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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