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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415176
Report Date: 04/04/2024
Date Signed: 04/04/2024 02:57:49 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
03/19/2024 and conducted by Evaluator Jessica Bongardt
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240319104342
FACILITY NAME:ACTION DAY PRIMARY PLUSFACILITY NUMBER:
434415176
ADMINISTRATOR:BATE, STEPHANIEFACILITY TYPE:
830
ADDRESS:2154 LINCOLN AVENUETELEPHONE:
(408) 266-8188
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:20CENSUS: 10DATE:
04/04/2024
UNANNOUNCEDTIME BEGAN:
02:17 PM
MET WITH:Lucy NunezTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff did not ensure that dishes used by infants were free of mold
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jessica Bongardt conducted a subsequent complaint visit and met with Lucy Nunez, Site Director today. The purpose of LPA’s visit was to deliver investigation findings.

During today’s visit, LPA conducted unannounced inspection of the facility. There was an accusation made that staff did not ensure that dishes used by infants were free of mold.

On March 22, 2024, and April 04, 2024, LPA conducted an unannounced inspections of the facility. During the course of the investigation, facility dishwashing protocols were reviewed, staff and parent interviews were conducted. Facility records were reviewed.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024
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-20240319104342
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: 434415176
VISIT DATE: 04/04/2024
NARRATIVE
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Based on investigation, file review, and interviews, it is concluded that although the allegation listed above 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.

Appeal rights were given.

A notice of Site Visit will be issued and must remained posted for 30 days.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2