434415146-11-20-2023-07-CC-GKUN-CXS2F6-20231120162100

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434415146
Report Date: 11/17/2023
Date Signed: 11/20/2023 09:34:35 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
07/24/2023 and conducted by Evaluator Anna Morales

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20230724162515

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: 158	DATE:	11/17/2023
		UNANNOUNCED	TIME BEGAN:	03:50 PM
MET WITH:	Ayah Shanawany		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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1. Lack of care/supervision resulting in child sustaining unexplained injury while in care.

INVESTIGATION FINDINGS:

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The investigation of the above allegation was conducted by the Community Care Licensing Division (CCLD) Investigations Bureau (IB). Investigator Bureau James Santos conducted the complaint investigation. The Investigator interviewed staff, reviewed facility files, and obtained copies of pertinent information. Based on interviews and even the surveillance video viewed by the parent, the cause of injury cannot be pinpointed to an incident that happened in the daycare.

Based on the evidence gathered by Investigator Bureau the allegation is found to be Unsubstantiated. A finding that is Unsubstantiated means although the allegation may have happened or is valid, the preponderance of evidence does not prove it.
Exit interview conducted and copy of this report was reviewed with the Director

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

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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