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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434404301
Report Date: 03/22/2021
Date Signed: 03/22/2021 11:25:15 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
09/28/2020 and conducted by Evaluator Anna Morales
COMPLAINT CONTROL NUMBER: 07-CC-20200928144814
FACILITY NAME:ASSOCIATED STUDENTS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434404301
ADMINISTRATOR:HEATHER VISEFACILITY TYPE:
850
ADDRESS:460 SOUTH EIGHTH STREETTELEPHONE:
(408) 924-6988
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY:72CENSUS: 44DATE:
03/22/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Heather ViseTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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1. Facility staff member had inappropriate interactions with youth in care.
2. Facility staff speak inappropriately to youth in care.
3. Facility staff handled day care child(ren) in a rough manner.
4. Facility staff hit day care child(ren) while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Morales conducted a Subsequent Tele-Investigation via tele-conference (via ZOOM) call with Program Director Heather Vise to inform her of the findings for the above allegations

This report with LPA's signature will be emailed to the Program Director. In lieu of Program Director's signature, her response to LPA's email will be the confirmation of receipt of this licensing report.

(page 1 of 2)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 07-CC-20200928144814
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ASSOCIATED STUDENTS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434404301
VISIT DATE: 03/22/2021
NARRATIVE
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The complaint investigation was conducted by Investigator Eddie Phung. Based on the supporting information obtained by Investigator Phung, the following allegations, Facility staff member had inappropriate interactions with youth in care, Facility staff speak inappropriately to youth in care, Facility staff handled day care child(ren) in a rough manner and Facility staff hit day care child(ren) while in care may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore, the allegation is found to be UNSUBSTANTIATED.


Exit interview conducted and copy of this report provided to the Director.
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2