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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417148
Report Date: 08/27/2025
Date Signed: 08/28/2025 12:15:48 PM

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
08/14/2025 and conducted by Evaluator Anna Morales
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20250814125125
FACILITY NAME:SANTA CLARA MONTESSORIFACILITY NUMBER:
434417148
ADMINISTRATOR:ARUNA DODLAFACILITY TYPE:
860
ADDRESS:3700 THOMAS ROAD, # 107TELEPHONE:
(669) 286-9924
CITY:SANTA CLARASTATE: CAZIP CODE:
95054
CAPACITY:26CENSUS: 20DATE:
08/27/2025
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Adriana MaganaTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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1. Facility does not follow Food Service Requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Anna Morales conducted an Unannounced Subsequent Complaint Investigation to deliver the findings for the above allegation. LPA was greeted by Director Adriana Magana and discussed the purpose of the visit.
Based on interviews and observation during the investigation, the food that is being served to the preschool children is being prepared at Owner Kyungmi "Katie" Gu's home and parents are not notified of changes made to the menu one week in advance, which does not meet all of the requirements for commercial Food Services as required under the Title 22 Regulations.
Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on the next page. Director was informed that failure to correct the deficiencies may result in civil penalties.
Exit interview was conducted with Director and discussed Plan of Correction(POC).Appeal Rights Given.
Notice of Site was issued and informed Director to post for 30 days in a visible location.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
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-20250814125125
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: SANTA CLARA MONTESSORI
FACILITY NUMBER: 434417148
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/10/2025
Section Cited
CCR
101227(13)(A)
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101227:Food Services:(13)If food is prepared off the center premises, the following shall apply:(A)The preparation source shall meet all applicable requirements for commercial food services.
This requirement was not met as evidenced by:
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Director will submit a plan to ensure that the food served at the facility meet all applicable requirements for commercial food services, by the POC(Plan of Correction) date,9/10/25.
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The Food being served to the preschool children is being prepared at the Owner's home which does not meet the all of the requirements for commercial food services, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
09/10/2025
Section Cited
CCR
101227(a)(6)
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101227:Food Services:
(a)In a child care centers providing meals to children, the following shall apply:(6)Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative.
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Director stated that she will submit a plan to ensure that children's representatives/parents will be notified if changes made(in advance) to the children's lunches by the POC(Plan of Correction) date, 9/10/25.
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Copies of the menus as served shall be dated and kept on file for at least 30 days. Menu's shall be made available for review by the child's authorized representative and the Department upon request:
This requirement was not met as evidenced by: Based on interviews conducted, children's representatives were not informed (in advance) that lunches served were not the same as posted on the lunch menu, which poses a potential health, safety or personal rights risk to persons 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: 08/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
08/14/2025 and conducted by Evaluator Anna Morales
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20250814125125

FACILITY NAME:SANTA CLARA MONTESSORIFACILITY NUMBER:
434417148
ADMINISTRATOR:ARUNA DODLAFACILITY TYPE:
860
ADDRESS:3700 THOMAS ROAD, # 107TELEPHONE:
(669) 286-9924
CITY:SANTA CLARASTATE: CAZIP CODE:
95054
CAPACITY:26CENSUS: 20DATE:
08/27/2025
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Adriana MaganaTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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1. Staff behavior poses as a risk to the daycare children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Anna Morales conducted an Unannounced Subsequent Complaint Investigation to deliver the findings for the above allegation. LPA was greeted by Director Adriana Magana and discussed the purpose of the visit.
During the complaint investigation, LPA interviewed Staff, parents and children. Staff stated that they have not observed behavior that poses as a risk to the day care children. Children interviewed stated that they like coming to preschool and all their teachers are nice. Parents interviewed stated that they have no concerns with the way the Staff are treating their child(ren).
LPA was unable to contact the Reporting Party to to obtain additional information.
Based on the interviews conducted with staff and record reviews, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the above allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Exit interview was conducted with Director Adriana Managa. Appeal Rights given. A Notice of Site Visit was issued and informed the Director to post in a visible location for 30 days.

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

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3