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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417603
Report Date: 04/21/2023
Date Signed: 04/21/2023 03:17:32 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/18/2023 and conducted by Evaluator Deanna Villagrana
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230418084357
FACILITY NAME:ROCHA ORTEGA, ANAFACILITY NUMBER:
434417603
ADMINISTRATOR:ANA ROCHA ORTEGAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 310-6788
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 5DATE:
04/21/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Ana Rocha OrtegaTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Licensee did not provide adequate supervision to the daycare children while in care
INVESTIGATION FINDINGS:
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Licensee Program Analyst (LPA) Deanna Villagrana met with licensee Ana Rocha Ortega to open investigation for above complaint. LPA explained the nature of the visit. Present were licensee, licensee's adult daughter Laura Rocha Ramos and five day care children including two infants.

Based on pertinent information obtained and interview which was conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. Licensee failed to provide adequate supervision to child in care causing child to be injured by another child in care. California Code of Regulations, Health and Safety Code 1596.80, are being cited on the attached LIC9099D.

The following type A deficiency was cited on the attached page (809-D). Licensee 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.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
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-20230418084357
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ROCHA ORTEGA, ANA
FACILITY NUMBER: 434417603
VISIT DATE: 04/21/2023
NARRATIVE
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LPA Deanna Villagrana informed licensee Ana Rocha Ortega that this report dated 04/21/2023 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deanna Villagrana informed the licensee Ana Rocha Ortega to provide a copy of this licensing report dated 04/21/2023 that documents any Type A citation(s) 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.

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

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 07-CC-20230418084357
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROCHA ORTEGA, ANA
FACILITY NUMBER: 434417603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/22/2023
Section Cited
CCR
102417(a)
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The licensee shall be present in the home and shall ensure that children in care are supervised at all times. This requirement was not met as evidenced by Licensee failed to provide adequate supervision to child in care causing child to be injured by another child in care.
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Licensee will submit a statement stating she understands children must be supervised at all times to ensure children are safe at all times.
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This poses an immediate risk to the Health, Safety or Personal Rights to 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: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3