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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434401958
Report Date: 07/14/2023
Date Signed: 07/14/2023 10:16:37 AM

Substantiated


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
04/04/2023 and conducted by Evaluator Fermin Campos-Jaramillo
COMPLAINT CONTROL NUMBER: 07-CC-20230404111612
FACILITY NAME:ARGUELLES, BERTHAFACILITY NUMBER:
434401958
ADMINISTRATOR:ARGUELLES, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 243-8267
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:14CENSUS: 9DATE:
07/14/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Bertha ArguellesTIME COMPLETED:
09:40 AM
ALLEGATION(S):
1
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5
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8
9
Daycare child sustained unexplained injuries while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met with Bertha Arguelles, licensee, for a follow up complaint investigation. The purpose of today inspection: Deliver the findings for the allegation stated above. Allegation was investigated by the Investigation Branch (IB).
LPA observed nine children were in care included four infants and five preschool age. Licensee's helper Gloria Garcia was also present in the Family Child Care Home.

Based on interviews, and information gathered during the investigation process, the Department concludes that a child had an unexplained injury, however it did not result in a deficiency of the title 22 Regulations, therefore not citations have been issued. It is thus concluded that the above allegation is found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
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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