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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417737
Report Date: 09/11/2026
Date Signed: 09/11/2026 03:07:22 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
07/21/2026 and conducted by Evaluator Pedro Jesus Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20260721094956
FACILITY NAME:CORDOVA, ANNELFACILITY NUMBER:
434417737
ADMINISTRATOR:ANNEL CORDOVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 417-6597
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: DATE:
09/11/2026
UNANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:Annel CordovaTIME COMPLETED:
03:17 PM
ALLEGATION(S):
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Licensee yells at daycare children.
Licensee does not ensure the daycare children are free of unusual punishment.
Licensee does not ensure daycare children are treated with dignity with his/her personal relationship with staff and other persons
INVESTIGATION FINDINGS:
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On 09/11/2026, Licensing Program Analysts (LPAs) Sara Mulugeta and Pedro Gutierrez conducted an unannounced visit to deliver findings. LPA met with licensee Annel Cordova and explained the reason for today’s visit. LPA toured the indoor and outdoor areas of the facility. Present were licensee, one assistant and six daycare children - three preschool age children and three infants. Information provided by the Reporting Party (RP) alleges that licensee yells at daycare children, licensee does not ensure the daycare children are free of unusual punishment, and licensee does not ensure daycare children are treated with dignity with his/her personal relationship with staff and other persons.

During the course of the investigation, LPA Pedro Gutierrez interviewed the reporting party, licensee, staff, children, and other involved parties, and reviewed facility and pertinent records. The interviews conducted and records reviewed did corroborate the above allegations, as interviews revealed that licensee yelled at children, licensee did not ensure daycare children were free of unusual punishment by wetting a child with water, and did not ensure daycare children are treated with dignity by withholding drinking water to a child in care until the child stopped crying.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Pedro Jesus Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2026
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 3
Control Number 07-CC-20260721094956
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: CORDOVA, ANNEL
FACILITY NUMBER: 434417737
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2026
Section Cited
CCR
102423(a)(4)
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102423(a)(4) - Personal rights - To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by…….
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Licensee will review Title 22 Regulations regarding personal rights and will write, sign, a date a letter stating...
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Based on interviews and record reviews, licensee wet a child with water as punishment. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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she understand the regulation and write a plan on how she will prevent physically punishments moving forward by plan of correction due date, 09/14/2026.
Type A
09/14/2026
Section Cited
CCR
102423(a)(1)
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102423(a)(1) - Personal rights - To be treated with dignity in his/her personal relationship with staff and other persons. This requirement was not met as evidenced by…
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Licensee will review Title 22 Regulations regarding personal rights and will write, sign, a date a letter stating...
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Based on interviews, it was disclosed that licensee withheld drinking water from a child until the child stopped crying. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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she understand the regulation and write a plan on how she will prevent withholding accommodations from children in care, my plan of correction due date, 09/14/2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Pedro Jesus Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20260721094956
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: CORDOVA, ANNEL
FACILITY NUMBER: 434417737
VISIT DATE: 09/11/2026
NARRATIVE
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This agency has investigated the complaint allegations. Based on LPA’s interviews and record reviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Per Title 22, Division 12, of the California Code of Regulations, the following Type A deficiencies are being cited: (see next page 9099D).
LPA Pedro Gutierrez informed Licensee Annel Cordova that this report dated 09/11/2026 document two Type A citations which shall be posted for 30 consecutive days as there are immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Pedro Gutierrez informed the Licensee Annel Cordova to provide a copy of this licensing report dated 09/11/2026 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 copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Licensee Annel Cordova.

Report was reviewed with the Licensee Annel Cordova. Appeal rights was handed to the licensee.

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: Susy Cervantes
LICENSING EVALUATOR NAME: Pedro Jesus Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3