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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417461
Report Date: 11/13/2025
Date Signed: 11/13/2025 05:44:31 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
05/07/2025 and conducted by Evaluator Anna Morales
COMPLAINT CONTROL NUMBER: 07-CC-20250507172058
FACILITY NAME:JIMENEZ AMEZOLA, GUILLERMOFACILITY NUMBER:
434417461
ADMINISTRATOR:GUILLERMO JIMENEZ AMEZOLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 278-5143
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY:14CENSUS: 0DATE:
11/13/2025
UNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Guillermo Jimenez/Herlinda LazoTIME COMPLETED:
05:55 PM
ALLEGATION(S):
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1. Staff member inappropriately touched child while in care.
INVESTIGATION FINDINGS:
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On 11/13/25, Licensing Program Analyst (LPA) Anna Morales conducted an unannounced complaint investigation today and met with licensee,Guillermo Jimenez and Herlinda Lazo to deliver investigation findings.

It was alleged that staff (S1) inappropriately touched child (C1) in C1’s private area. Another child (C2), was alleged to be exhibiting unusual behavior. When C2 was asked by C2’s parent who showed C2 that, C2 mentioned S1’s name.

The investigation revealed that S1 had been alone with C1 on multiple occasions. C1 went through a multi-disciplinary interview and provided consistent statements.
Based on record reviews and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
Continue on LIC9099C........
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
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-20250507172058
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: JIMENEZ AMEZOLA, GUILLERMO
FACILITY NUMBER: 434417461
VISIT DATE: 11/13/2025
NARRATIVE
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LPA Anna Morales informed licensee that this report dated, 11/13/25, document(s)one Type A citation, which shall be posted for 30 consecutive days as there are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Anna Morales informed the licensee to provide a copy of this licensing report dated 11/13/25 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.

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



Exit interview conducted and report was reviewed with Licensee Guillermo Jimenez and Herlinda Lazo.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20250507172058
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: JIMENEZ AMEZOLA, GUILLERMO
FACILITY NUMBER: 434417461
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/14/2025
Section Cited
CCR
102423(a)(1)
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Personal Rights:102423(a)(1) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative.
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Licensee shall submit a written plan of correction(POC) by 11/14 /2025, that will ensure that children's personal rights will not be violated.
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These rights include, but are not limited to, the following: (1)To be treated with dignity in his/her personal relationship with staff and other persons.
This requirement was not met as evidenced by:
Based on information obtained, S1 inappropriately touched child while in care. This poses an immediate risk to the safety of the 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: 11/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3