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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444416000
Report Date: 11/15/2022
Date Signed: 11/15/2022 09:59:59 AM

Unsubstantiated


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
10/06/2022 and conducted by Evaluator Susy Cervantes
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20221006142603
FACILITY NAME:CALDERON, KARINAFACILITY NUMBER:
444416000
ADMINISTRATOR:KARINA CALDERONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 288-0261
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 8DATE:
11/15/2022
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Karina CalderonTIME COMPLETED:
10:10 AM
ALLEGATION(S):
1
2
3
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5
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8
9
Provider handled daycare children in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
On 11/15/2022 at 9:25 AM, Licensing Program Analyst (LPA) Susy Cervantes, met with licensee, Karina Calderon, to deliver complaint findings. Present was licensee and their assistant, Elvia Abrego, with 8 children in care: 3 infants and 5 preschool age children.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited during today's visit. 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. Exit interview conducted and report was reviewed in Spanish with licensee, Karina Calderon.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
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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