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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430701361
Report Date: 11/30/2023
Date Signed: 11/30/2023 10:18:04 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
09/21/2023 and conducted by Evaluator Janette Cruz
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230921122029
FACILITY NAME:ACTION DAY NURSERYFACILITY NUMBER:
430701361
ADMINISTRATOR:BATE, STEPHANIEFACILITY TYPE:
850
ADDRESS:2146 LINCOLN AVENUETELEPHONE:
(408) 266-8952
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:154CENSUS: 114DATE:
11/30/2023
UNANNOUNCEDTIME BEGAN:
08:19 AM
MET WITH:Zeenah Ali & Jamie FergusonTIME COMPLETED:
08:50 AM
ALLEGATION(S):
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9
Staff exposed daycare children to hazardous chemicals while in care.
Unqualified staff caring for daycare children.
Facility is operating out of ratio.
INVESTIGATION FINDINGS:
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2
3
4
5
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7
8
9
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12
13
Licensing Program Analyst (LPA) Janette Cruz met with Zeennah Ali, office assistant and Jamie Ferguson, Regional Director for an unannounced complaint investigation and deliver investigation findings. LPA discussed the complaint allegations with Zeennah and Jamie.

The investigation of the complaint allegation listed in this complaint was conducted by LPA Janette Cruz. Based on evidence gathered, including record/document reviews, and interviews completed for the complaint investigation, it is concluded that although the allegations noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with Jamie Ferguson, Regional Director.

A notice of site visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
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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