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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444406204
Report Date: 12/19/2023
Date Signed: 12/19/2023 10:18:44 AM

Unsubstantiated


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
10/26/2023 and conducted by Evaluator Teodoro Trujillo
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20231026151510
FACILITY NAME:DA SILVA, MARTHAFACILITY NUMBER:
444406204
ADMINISTRATOR:DA SILVA, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-1854
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 9DATE:
12/19/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Martha Da SilvaTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Teodoro Trujillo conducted an unannounced subsequent complaint visit to the child care home today. LPA met with licensee Martha Da Silva and explained the reason for the visit. Present were licensee, licensee's adult son Daniel and assistant Luz and 9 day care children: two infants and seven preschool age.
During the course of this investigation, LPA conducted observation and reviewed documents. LPAs also interviewed staff, and parents.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited today. The investigation report was discussed and report was translated into Spanish during the exit interview with Licensee, Martha Da Silva.
NOTICE OF SITE VISIT WAS PRINTED AND HANDED TO THE LICENSEE, MUST BE POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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