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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434405574
Report Date: 10/23/2024
Date Signed: 10/23/2024 05:31:33 PM

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
09/12/2024 and conducted by Evaluator Samantha Yip
COMPLAINT CONTROL NUMBER: 07-CC-20240912111241
FACILITY NAME:HERNANDEZ, MARIAFACILITY NUMBER:
434405574
ADMINISTRATOR:HERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 729-4974
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 12DATE:
10/23/2024
UNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Maria HernandezTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not treat child(ren) with respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation. LPA met with Licensee Maria Hernandez and explained the reason for the inspection.

During the course of this investigation, LPA conducted observation. LPA interviewed staff, children, and third party. Based on the information obtained, the above allegation is found to be UNSUBSTANTIATED, meaning although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were issued as a result of this investigation. Exit interview conducted and report was reviewed with Licensee Maria Hernandez. A notice of site visit has been issued and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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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