434417019-6-21-2024-07-CC-BDEL-D6L2K6-20240625172725

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434417019
Report Date: 06/21/2024
Date Signed: 06/21/2024 09:47:45 AM

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
03/28/2024 and conducted by Evaluator Melvin S Matos

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20240328144022

FACILITY NAME:	AGNEW DISTRICT PRESCHOOL		FACILITY NUMBER:	434417019
ADMINISTRATOR:	NATACHA COSTA		FACILITY TYPE:	850
ADDRESS:	3534 ZANKER ROAD		TELEPHONE:	(669) 369-4185
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95134
CAPACITY:	48	CENSUS: 27	DATE:	06/21/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Maria De La Torre		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff injured child while in care

Staff yelled at day care children

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mel Matos met with Maria De La Torre, interim summer director, for a follow up complaint investigation to deliver investigation findings. Based on interviews, observations, record reviews, and evidence gathered during the investigation process, it is concluded that although the allegations noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with the interim summer director, Maria De La Torre. No deficiencies issued. A notice of site visit was given and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

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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