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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 274417732
Report Date: 06/06/2024
Date Signed: 06/06/2024 11:10:14 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
04/23/2024 and conducted by Evaluator Deanna Villagrana
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240423102814
FACILITY NAME:GASCA, SELENEFACILITY NUMBER:
274417732
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/06/2024
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Severo Gasca PantojaTIME COMPLETED:
11:20 AM
ALLEGATION(S):
1
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9
Licensee did not provide appropriate supervision to day care children
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Deanna Villagrana met with licensee's brother in law Severo Gasca Pantoja to deliver finding for above allegation. Licensee was not present in the home and currently out of the country. Present were licensee's brother in law and sister in law. LPA did not observed any children in the home.

LPA contacted licensee by phone and explained the nature of the visit. LPA delivered findings by phone and requested permission to leave the report with brother in law Severo. Licensee agreed. Based on interviews conducted, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiency was cited.

Notice of site visit was issued and must be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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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