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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434408035
Report Date: 12/12/2023
Date Signed: 12/12/2023 03:23:36 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2023 and conducted by Evaluator Melanie Otsuji
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20231006094047
FACILITY NAME:AMES CHILD CARE CENTERFACILITY NUMBER:
434408035
ADMINISTRATOR:LAM, HENRYFACILITY TYPE:
850
ADDRESS:BLDG 270 R.T. JONES ROADTELEPHONE:
(650) 604-5100
CITY:MOFFETT FIELDSTATE: CAZIP CODE:
94035
CAPACITY:75CENSUS: 40DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Thao "Kryssie" NguyenTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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- Staff hit children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conclude investigation into the above allegation. LPA was met by Acting Director, Thao "Kryssie" Nguyen. Also present today were 8 additional staff members and 40 preschool aged children.

During the course of the investigation multiple interviews stated that they either observed or heard of S1 "bopping" a child on the head with a soft block and playfully hitting a child on the back. Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC. 9099D.
Exit interview conducted with Acting Director, Kryssie Nguyen. Appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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 52-CC-20231006094047
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AMES CHILD CARE CENTER
FACILITY NUMBER: 434408035
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/02/2024
Section Cited
CCR
101223(a)(2)
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To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Director is to have staff watch the Children's Personal Rights in Child Care video at https://ccld.childcarevideos.org. Written statement with staff signatures confirming they have watched the video to be submitted to LPA no later than 1/2/2024.
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-This regulation is not being met as evidence by: multiple interviewees state that they observed or heard of S11 "bopping" a child on the head with a soft block and S11 hitting a child on the back resulting in the children crying. Which poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2