Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434413597
Report Date: 09/19/2016
Date Signed 09/19/2016 01:33:27 PM


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
06/23/2016 and conducted by Evaluator Jean Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20160623103221
FACILITY NAME:HEARTS AND HANDS CHRISTIAN CHILDCARE AND PRESCHOOLFACILITY NUMBER:
434413597
ADMINISTRATOR:STACY E. SILVEYFACILITY TYPE:
850
ADDRESS:400 LLEWELLYN AVENUETELEPHONE:
(408) 412-8823
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:70CENSUS: 38DATE:
09/19/2016
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Stacey SilveyTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Facility does not provide children a safe environment.
INVESTIGATION FINDINGS:
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Children's nap cots have been placed under the hanging cubbies. The cubbies have loose plastic bins in them. It is possible if there was an earthquake the bins could become dislodged and fall on a child. Based on Analyst's observations the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Jean WaltonTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2016
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-20160623103221

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: HEARTS AND HANDS CHRISTIAN CHILDCARE AND PRESCHOOL
FACILITY NUMBER: 434413597
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2016
Section Cited
101238(a)
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BUILDING AND GROUNDS - The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees, and visitors. Children's nap cots have been placed under the hanging cubbies. If there was an earthquake it is possible the plastic bins could become dislodged and fall on a child.
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Center will no longer place napping children under the hanging cubbies and send a written statement stating all staff have been a instructed to no longer place children on cots under the hanging cubbies.
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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.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Jean WaltonTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2016
LIC9099 (FAS) - (06/04)
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