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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430706089
Report Date: 07/11/2023
Date Signed: 07/11/2023 09:27:22 AM

Unsubstantiated


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
03/30/2023 and conducted by Evaluator Ashley Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230330150558

FACILITY NAME:CAMPBELL CHRISTIAN EARLY CHILDHOOD CENTERFACILITY NUMBER:
430706089
ADMINISTRATOR:KATHY HARMONFACILITY TYPE:
850
ADDRESS:1075 WEST CAMPBELL AVE.TELEPHONE:
(408) 370-4900
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:116CENSUS: DATE:
07/11/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Erin KnickerbockerTIME COMPLETED:
09:40 AM
ALLEGATION(S):
1
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9
Staff called day care child an inappropriate name
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
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13
Licensing Program Analyst (LPA), Ashley Lopez conducted an unannounced complaint inspection and met with Assistant Director Erin Knickerbocker. The purpose of the inspection was to deliver the investigation findings for the above complaint allegation.

The investigation of the above allegation was conducted by the Community Care Licensing Division (CCLD) Investigations Bureau and LPA. Investigator Blake Williams conducted the initial complaint investigation. The Investigator interviewed staff, reviewed facility files, and obtained copies of pertinent information. LPA Macias also interviewed staff. Based on the evidence gathered by Investigator Williams and LPA Macias the allegation is found to be UNSUBSTANTIATED, meaning the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and copy of this report was reviewed with Assistant Director, Erin Knickerbocker.

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:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
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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