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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434408755
Report Date: 06/02/2025
Date Signed: 06/02/2025 02:44:54 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
05/16/2025 and conducted by Evaluator Andy Yang
COMPLAINT CONTROL NUMBER: 07-CC-20250516083616
FACILITY NAME:ACTION DAY PRIMARY PLUSFACILITY NUMBER:
434408755
ADMINISTRATOR:FARRAH DERLAFACILITY TYPE:
850
ADDRESS:5845 ALLEN AVENUETELEPHONE:
(408) 629-6020
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:254CENSUS: 41DATE:
06/02/2025
UNANNOUNCEDTIME BEGAN:
12:29 PM
MET WITH:Farrah Derla TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Ratio - Staff did not ensure they were not out of ratio
Personal Rights - Staff are not meeting day care child's diapering needs
INVESTIGATION FINDINGS:
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On 6/02/2025, Licensing Program Analyst (LPA) Andy Yang conducted an unannounced complaint investigation. LPA met with Director, Farrah Derla to deliver the complaint allegations of personal rights - staff are not meeting day care child’s diaper needs and ratio - staff did not ensure they were out of ratio. Present for today's inspection were Director, (6) Teachers, and (41) children. LPA toured the indoor areas of the facility with licensee.

During the investigation, LPA interviewed children, parents, teachers, and the Director. Despite the allegations that teachers were out of ratio during drop off time in the morning and teachers not meeting child’s diaper needs, interviews and observations did not reveal the (2) allegations that were reported on the facility.

***Continue Page 2***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2025
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-20250516083616
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: 06/02/2025
NARRATIVE
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***Page 2***

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiency issued for this allegation. Appeal Rights provided.



A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2