434415146-6-1-2023-07-CC-DSTN-CTWVPR-20230720163709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434415146
Report Date: 06/01/2023
Date Signed: 06/01/2023 02:07:27 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 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
05/03/2023 and conducted by Evaluator Kassandra Medrano

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20230503091646

FACILITY NAME:	PRIMROSE SCHOOL OF WILLOW GLEN		FACILITY NUMBER:	434415146
ADMINISTRATOR:	SHANAWANY,AYAH		FACILITY TYPE:	850
ADDRESS:	1496 HAMILTON AVENUE		TELEPHONE:	(669) 273-6169
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	174	CENSUS: 187	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Ayah Shanawany & Monica Thompson		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not adhering to proper food service requirements.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kassandra Medrano, conducted a subsequent site visit to the facility to deliver investigation findings. LPA met with Ayah Shanawany, Site Director and Monica Thompson, Executive Director the purpose of the visit was explained.

During the course of the investigation, LPA interviewed staff, gathered pertinent information, and made classroom observations. Based on the information obtained, the above allegation is found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met. During the course of the investigation it was found that children were not receiving the proper portion sizes of food which lead to children not receiving adequate amounts of food.

As a result of this inspection, California Code of Regulations, Title 22 type b deficiency is being cited on the following page(s):

Exit interview conducted and report was reviewed with directors, Monica Thompson and Ayah Shanaway A notice of site visit has been issued and must remain posted for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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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Control Number 07-CC-20230503091646

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PRIMROSE SCHOOL OF WILLOW GLEN	FACILITY NUMBER: 434415146
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/15/2023 Section Cited CCR 101227(a)(1)	1 2 3 4 5 6 7	101227(a)(1) Food Services (a) In child care centers providing meals to children, the following shall apply:(1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Directors stated that they will have the chef send daily email updates on food supply in order to track how much food is left in the facility. Directors to conduct a staff meeting to discuss portion sizes when modeling food consumption. Directors to send documentation of both POC's by 06/15/2023.
	8 9 10 11 12 13 14	Based on interviews with staff it was stated that the facility has not had adequate amounts of food for children. It was stated that staff will consume the food designated for children to model eating. This poses a potential risk to children in care	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

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