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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444400083
Report Date: 05/13/2022
Date Signed: 05/20/2022 01:45:46 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
04/14/2022 and conducted by Evaluator Cortney Nelson
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220414121751
FACILITY NAME:TERRY JIMENEZ CHILDREN'S CENTERFACILITY NUMBER:
444400083
ADMINISTRATOR:L GONZALEZ/E MARINFACILITY TYPE:
850
ADDRESS:201 BREWINGTON AVENUETELEPHONE:
(831) 713-7427
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:34CENSUS: 17DATE:
05/13/2022
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Ramona McCabeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff handles day care children in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Cortney Nelson, met with Senior Manager, Ramona McCabe, and explained purpose of visit, conduct child interviews and deliver complaint investigation findings for above allegation.

LPA Nelson conducted interviews with staff, children and parents from the facility, reviewed pertinent documents, such as staff files, and observed staff while in the classroom and outside with children. Based on observation and interviews, children reported arm grabbing and LPA observed forearm grabbing by staff 1. The preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.

California Code of Regulations (Title 22, Division 12) are being cited on attached LIC9099-D.


***Report continued on LIC9099-C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
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-20220414121751
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: TERRY JIMENEZ CHILDREN'S CENTER
FACILITY NUMBER: 444400083
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2022
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met as evidenced by:
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Licensee will discuss proper discipline strategies with all staff and submit documentation of training. Documentation should include names of teachers present, discipline strategies discussed, and proper ways to physically handle preschool children.
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Based on classroom observation and 4 out of 5 children interviews, staff 1 is handing children in a rough manner and did not ensure that children were accorded their personal rights which poses an immediate health and safety risk to children in care.
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Documentation should be submitted to Licensing by 5/27/2022 and all staff employed at facility must conduct training.
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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: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20220414121751
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: TERRY JIMENEZ CHILDREN'S CENTER
FACILITY NUMBER: 444400083
VISIT DATE: 05/13/2022
NARRATIVE
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A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.

LPA informed Senior Manager, Ramona, that this report dated 5/13/2022 documents one Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the licensee to provide a copy of this licensing report dated (5/13/2022) that documents any Type A citation 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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3