434417245-6-12-2026-07-CC-MFLS-DV3VMQ-20260615163356

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434417245
Report Date: 06/12/2026
Date Signed: 06/12/2026 03:25:18 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
03/18/2026 and conducted by Evaluator Pedro Jesus Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20260318083134

FACILITY NAME:	SJB ROULEAU CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434417245
ADMINISTRATOR:	IYARE ISIBOR		FACILITY TYPE:	860
ADDRESS:	1875 MONROVIA DRIVE		TELEPHONE:	(408) 573-4713
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95122
CAPACITY:	36	CENSUS: 24	DATE:	06/12/2026
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Iyare Isibor		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Staff did not obtain emergency medical treatment in a timely manner resulting in child being hospitalized

INVESTIGATION FINDINGS:

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On 06/12/2026, Licensing Program Analyst (LPA) Pedro Gutierrez conducted a visit to deliver findings. LPA met with Site Supervisor Iyare Isibor and explained the reason for today’s visit. LPA toured the indoor and outdoor areas of the facility. Present were Site Supervisor, six staff, and 24 daycare children - 22 preschool age and two infants.

Information provided by the Reporting Party (RP) alleges that staff did not obtain emergency medical treatment in a timely manner resulting in child being hospitalized.

During the course of the investigation, LPA Pedro Gutierrez interviewed the reporting party, site supervisor, staff, and other involved parties, and reviewed facility and pertinent records.
***** End of page 1 of 3 *****

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mireya Flores
LICENSING EVALUATOR NAME: Pedro Jesus Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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 4

Control Number 07-CC-20260318083134

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: SJB ROULEAU CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434417245
	VISIT DATE: 06/12/2026

NARRATIVE

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Based on records review, the child had prescribed emergency medication to be administered immediately in the event of an allergic reaction. The facility’s policies identify severe allergic reactions/anaphylaxis as examples of situations in which emergency medical services must be contacted immediately.
Based on interview disclosures it was revealed that staff did not administer the prescribed medication as required. It was also confirmed that staff did not call 9-1-1 in a timely manner when the child began exhibiting symptoms consistent with anaphylaxis. Emergency medical services were not contacted until requested by the child’s mother who arrived at the facility and observed the child’s condition.

The failure to administer the prescribed medication and the delay in seeking emergency medical treatment posed an immediate health and safety risk to the child.

Based on LPAs record reviews, and interviews which were conducted, it was determined that a child in care experienced a severe anaphylaxis reaction while present at the facility and therefore the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
The following type A deficiency was cited on the attached page (9099-D). Site Supervisor was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

LPA Pedro Gutierrez informed Site Supervisor Iyare Isibor that this report dated 06/12/2026 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

SUPERVISORS NAME: Mireya Flores
LICENSING EVALUATOR NAME: Pedro Jesus Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 07-CC-20260318083134

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: SJB ROULEAU CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434417245
	VISIT DATE: 06/12/2026

NARRATIVE

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Also, LPA Pedro Gutierrez informed the Site Supervisor Iyare Isibor to provide a copy of this licensing report dated 06/12/2026 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted and the report was reviewed with the Site supervisor Iyare Isibor. Appeal rights was handed to the Site Supervisor.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Mireya Flores
LICENSING EVALUATOR NAME: Pedro Jesus Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 07-CC-20260318083134

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: SJB ROULEAU CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434417245
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/15/2026 Section Cited CCR 101226(c)	1 2 3 4 5 6 7	101226 Health-Related Services(c): The licensee shall obtain emergency medical treatment without specific instructions from the child's authorized representative if the authorized representative cannot be reached immediately, or if the nature of the child's illness or injury is such that there should be no delay in getting medical treatment for the child.	1 2 3 4 5 6 7	Per the Site Supervisor, she will complete the Child Care Center Online Orientation to ensure full understanding of regulatory requirements and emergency response procedures. Proof of completion will be submitted to the Department by Plan of Correction due date, 06/15/2026. Per the Site Supervisor, they will develop, document, and submit a written training plan and training materials which will outline how all staff will be trained on identifying medical emergencies and the requirement to call 9-1-1 immediately during any situation involving severe allergic reactions or anaphylaxis by Plan of Correction due date, 06/15/2026.
	8 9 10 11 12 13 14	This regulation was not met as evidenced by, interview disclosures and records reviews, it was determined that a child in care experienced a severe anaphylactic reaction at the facility, the center failed to administer the prescribed medication, and there was a delay in seeking emergency medical services. This poses an immediate risk to the health and safety of the children in care.	8 9 10 11 12 13 14
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Mireya Flores
LICENSING EVALUATOR NAME: Pedro Jesus Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC9099 (FAS) - (06/04)

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