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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416299
Report Date: 04/14/2022
Date Signed: 04/14/2022 10:28:52 AM

Unsubstantiated


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
02/28/2022 and conducted by Evaluator Anna Morales
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220228113942
FACILITY NAME:LAZO SAMANIEGO, HERLINDAFACILITY NUMBER:
434416299
ADMINISTRATOR:LAZO SAMANIEGO, H.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 278-5143
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY:14CENSUS: 1DATE:
04/14/2022
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Herlinda LazoTIME COMPLETED:
09:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1. Licensee yells at children in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Anna Morales conducted a subsequent investigation to deliver the findings of the above allegation. LPA was greeted by Licensee Herlinda Lazo. Also present was one child( 4-5) years of age.

Complainant alleges that, Licensee yells at children in care. LPA obtained information from the interviews that were conducted with the Licensee, staff, parents and other parties involved. LPA, also, reviewed supporting documentation, which included the Facility Roster.

Based on the information obtained, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore, the allegation is found to be UNSUBSTANTIATED.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
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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