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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434408755
Report Date: 06/18/2026
Date Signed: 06/18/2026 02:13:27 PM

Substantiated


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
06/11/2026 and conducted by Evaluator Andy Yang
COMPLAINT CONTROL NUMBER: 07-CC-20260611081700
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: 80DATE:
06/18/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ortencia GuzmanTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Other - Staff did not ensure children had access to water while outside.
INVESTIGATION FINDINGS:
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On 6/18/2026, Licensing Program Analyst (LPA) Andy Yang conducted an unannounced complaint investigation, and to deliver the complaint allegation listed above. LPA met with Director, Ortencia "Missy" Guzman and discussed the complaint allegation with them. Present for today’s investigation were Director, (8) staff, and (80) children. LPA toured the indoor and outdoor areas.

LPA interviewed staff, and the director. LPA conducted children interactions, observations, and collected documents.

Allegation stated that staff did not ensure children had access to water while outside. It was reported that teachers in classroom K4 did not provide water to children in care during outdoor playtime. Based on the result of the investigation, staff S1&S2 stated that one day in June during afternoon outddoor playtime, they did not ensure children had access to water while outside. The duration of outdoor play at that time was no more than 20 minutes due to the warm temperature that day.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mireya Flores
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026
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-20260611081700
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: 06/18/2026
NARRATIVE
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***Page 2***

Based on LPA’s observation, interactions, and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED California Code of Regulations, 101239.2(a), and Technical Violation is issued.


No deficiency issued for this allegation. Appeal Rights provided.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Ortencia "Missy" Guzman.
SUPERVISORS NAME: Mireya Flores
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2