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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417125
Report Date: 07/15/2024
Date Signed: 07/15/2024 09:58:44 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
05/17/2024 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240517165823
FACILITY NAME:VARGAS CAMACHO, MARIAFACILITY NUMBER:
434417125
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
07/15/2024
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Maria Vargas CamachoTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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9
Licensee using unusual forms of punishment

Uncleared adults residing in the day care home

Licensee allows minor to provide care and supervision to day care children
INVESTIGATION FINDINGS:
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2
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8
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Licensing Program Analyst (LPA) Mel Matos met with Maria Vargas Camacho, Licensee, for an unannounced 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, Maria Vargas Camacho. 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: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
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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