434408755-12-18-2024-07-CC-GKUN-DCGPY8-20241231104328

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434408755
Report Date: 12/18/2024
Date Signed: 12/18/2024 03:23:08 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
12/05/2024 and conducted by Evaluator Anna Morales

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20241205160644

FACILITY NAME:	ACTION DAY PRIMARY PLUS		FACILITY NUMBER:	434408755
ADMINISTRATOR:	FARRAH DERLA		FACILITY TYPE:	850
ADDRESS:	5845 ALLEN AVENUE		TELEPHONE:	(408) 629-6020
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	254	CENSUS: 133	DATE:	12/18/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Farrah Derla		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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1. Child sustained unexplained injuries while in care due to Lack of Supervision.
2. Children left unsupervised in a classroom.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Morales conducted a Subsequent Complaint visit to deliver the findings for the above allegations. LPA met with Director Farrah Derla.

On 12/10/24 and on12/12/24, LPA Anna Morales conducted interviews with staff, children and reviewed supporting documentation. Observations were made in each of the classrooms( K1,K2,K3, K4,K5,and Rooms 3, 4,10). On both days, LPA observed that staff were present and observed to be in compliance with teacher to child ratio requirement.
Staff interviewed stated that if they observe any visible marks such as bruises, scratches, or if a child sustains an injury while at the center, they will notify the child's parent or responsible party. Staff, also, stated that an Ouch report will be completed and given to the child's parent or responsible party.
--Continue on LIC9099C------

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

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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Control Number 07-CC-20241205160644

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ACTION DAY PRIMARY PLUS	FACILITY NUMBER: 434408755
	VISIT DATE: 12/18/2024

NARRATIVE

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One of the staff interviewed stated that a preschool aged child (C1) sustained an injury while playing outside in the playground approximately in November 2024,parents were notified and an OUCH report issued.

Children interviewed stated that they observed C1(Child) sustained an injury and staff were present, Staff stated that C1(Child) parent/responsible party was notified and an Ouch Report was completed. LPA reviewed that an OUCH report was completed for dates 10/30/24 and for 11/5/24.
Staff stated that they did not observe any visible bruises or other marks on C1(Child), and would have have notified C1's(Child)parents/responsible party if observed.

On 12/17/24, LPA conducted interviews with parents who stated that the staff do notify them if their child(ren) obtains an injury and give them an written report.

The Reporting Party of Child (C1) sustained unexplained bruises and marks while at the preschool, however, LPA was unable to reach the Reporting Party to obtained additional information.

Children interviewed stated that they are never left unattended inside the classrooms and there is always a teacher present. Staff interviewed disclosed that they move from classroom to classroom to ensure that they remain in Ratio, and never leave the children unattended. Parents interviewed disclosed that they always see staff inside the classroom(s) during drop off and at pick up.
Based on LPA’s observations, records review, and interviews completed for this complaint investigation, it is concluded that although the allegations noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED.

NOTICE OF SITE VISIT WAS ISSUED AND WAS INFORMED TO THE DIRECTOR TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

LIC9099 (FAS) - (06/04)

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