434408755-11-8-2023-07-CC-JSEA-CZ637Z-20240103170047

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434408755
Report Date: 11/08/2023
Date Signed: 11/08/2023 03:07:34 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, 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
09/29/2023 and conducted by Evaluator Samantha Yip

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20230929154852

FACILITY NAME:	ACTION DAY PRIMARY PLUS		FACILITY NUMBER:	434408755
ADMINISTRATOR:	RITIPAL(NEEKA)JUNEJA		FACILITY TYPE:	850
ADDRESS:	5845 ALLEN AVENUE		TELEPHONE:	(408) 629-6020
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	254	CENSUS: 139	DATE:	11/08/2023
		UNANNOUNCED	TIME BEGAN:	12:13 PM
MET WITH:	Georgia Robello		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Staff handled day care child in an inappropriate manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation. LPA met with Director Georgia Robello and explained the reason for the inspection.

During the course of this investigation, LPA conducted interviews with staff, children, and parents. LPA reviewed parent and employee handbook. LPA also reviewed staff meeting agenda dated 08/30/2023. LPA also reviewed additional documents. Based on the information obtained, the above allegation is found

--------------CONTINUES ON 9099 DATED 11/08/2023 PAGE 2-----------------

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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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Control Number 07-CC-20230929154852

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: ACTION DAY PRIMARY PLUS	FACILITY NUMBER: 434408755
	VISIT DATE: 11/08/2023

NARRATIVE

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--------------CONTINUATION OF 9099 DATED 11/08/2023 PAGE 1--------------

to be SUBSTANTIATED, meaning the preponderance of the evidence standard has been met.

Based on record review and interviews, there was incident involving A-1 and a violation of child's personal rights. Director stated that the center conducted their own investigation. A-1 was let go.

As a result of this investigation, a Type A citation was issued. Exit interview conducted and report was reviewed with Director Georgia Robello. A notice of site visit has been issued and must remain posted for 30 days.

LPA Samantha Yip informed Director Georgia Robello that this report dated 11/08/2023 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Director to provide a copy of this licensing report dated 11/08/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 07-CC-20230929154852

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: ACTION DAY PRIMARY PLUS	FACILITY NUMBER: 434408755
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/09/2023 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	Personal Rights. The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	By 11/09/2023, facility will submit written plan outlining how they will ensure that children's personal rights are not violated.
	8 9 10 11 12 13 14	Based on record review and interview, there was an incident involving A-1 and a violation of child's personal rights. A-1 was let go. This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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