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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416401
Report Date: 09/28/2021
Date Signed: 09/28/2021 01:08:09 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
08/18/2021 and conducted by Evaluator Susy Cervantes
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210818135407
FACILITY NAME:CASTANO, ANGIEFACILITY NUMBER:
434416401
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
09/28/2021
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Angie CastanoTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Lack of supervision
INVESTIGATION FINDINGS:
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On 09/28/2021 at 12:50 PM, Licensing Program Analyst (LPA), Susy Cervantes, met with licensee, Angie Castano to deliver complaint findings. Present were licensee with 5 children: 2 preschool and 3 infants.

Based on LPAs observations, record review, and interviews which were conducted, on or about 08/26/21, licensee left a daycare child with an unqualified adult, the adult did not have current CPR and first aid certification, immunizations for spouse were provided, LPA took a picture; the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

LPA conducted an exit interview with licensee in Spanish. Type B deficiencies cited. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. Appeal rights and Notice of Site visit were provided. Notice of Site visit must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
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-20210818135407
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: CASTANO, ANGIE
FACILITY NUMBER: 434416401
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/12/2021
Section Cited
HSC
1596.8669(b)
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1596.8669(b) Additional health and safety training; condition of licensure
Day care center directors and licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR...shall be onsite at all times when children are present at the facility... This requirement was not met as evidenced by:
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Licensee will review staff requirements and submit a written statement of their understanding of the requirements and their plan to ensure a qualified adult is present when children in care are present.
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Based on interviews and record reviews, licensee was unable to provide current CPR and first aid training for their spouse who was left alone with a child in care. This poses a potential risk t the health and safety of the childrne in care.
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Statement will be submited to the San Jose Regonal Office by close of business on October 12, 2021.
HSC
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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: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2