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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415176
Report Date: 07/29/2026
Date Signed: 07/29/2026 10:17:35 AM

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
05/28/2026 and conducted by Evaluator Linke Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20260528144449
FACILITY NAME:ACTION DAY PRIMARY PLUSFACILITY NUMBER:
434415176
ADMINISTRATOR:JENNY DOFACILITY TYPE:
830
ADDRESS:2154 LINCOLN AVENUETELEPHONE:
(408) 266-8188
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:20CENSUS: 14DATE:
07/29/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jamie FergusonTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff did not meet the infant's feeding care needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kate Huang conducted an unannounced complaint visit to deliver investigation findings regarding the above allegation. LPA met with Facility Representative Jamie Ferguson and explained the nature of today’s inspection.

It was alleged that staff missed feeding one milk bottle to an infant (C1).

During the course of the investigation, LPA conducted facility inspections on 06/03/2026, 06/16/2026 and 07/14/2026; interviewed staff members, the director, and the site supervisor; and reviewed C1’s daily activity report. All individuals interviewed acknowledged that on 05/27/2026, C1 was not given milk after her first bottle at 8:00 a.m. until her second bottle at 4:29 p.m. Interviews revealed that the staff responsible for C1 forgot to check C1’s feeding schedule. The daily activity report for C1 indicated she received her first bottle at 8:00 a.m. and her second bottle at 4:29 p.m., and that C1 was fed puree twice between those times. Additionally, C1’s Needs and Services Plan indicates that she needs to be fed every 4 hours.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
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 4
Control Number 07-CC-20260528144449
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: 434415176
VISIT DATE: 07/29/2026
NARRATIVE
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Based on the evidence gathered, the preponderance of evidence standard has been met and therefore the above allegation is Substantiated.

One TYPE B deficiency was cited today as a result of the investigation. The report was reviewed and discussed with the facility representative, Jamie Ferguson. Appeal rights were provided.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20260528144449
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: 434415176
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/07/2026
Section Cited
CCR
101427(c)(1)
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101427(c) The infant shall be fed in accordance with the individual plan. (1) Bottled-fed infants shall be fed at least once every four hours.

This requirement was not met as evidenced by:
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Licensee to provide a plan of correction by the POC due date.
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Based on interviews and records reviewed, the licensee did not comply with the section cited above because on 05/27/2026, one infant was not given milk after her first bottle at 8:00 a.m. until her second bottle at 4:29 p.m., as staff forgot to check her feeding schedule, which posed a potential health, safety, or personal rights risk to persons in care.
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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: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
05/28/2026 and conducted by Evaluator Linke Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20260528144449

FACILITY NAME:ACTION DAY PRIMARY PLUSFACILITY NUMBER:
434415176
ADMINISTRATOR:JENNY DOFACILITY TYPE:
830
ADDRESS:2154 LINCOLN AVENUETELEPHONE:
(408) 266-8188
CITY:SAN JOSESTATE:CAZIP CODE:
95125
CAPACITY:20CENSUS: 14DATE:
07/29/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jamie FergusonTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff did not maintain proper staff-infant ratios
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kate Huang conducted an unannounced complaint visit to deliver investigation findings regarding the above allegation. LPA met with Facility Representative Jamie Ferguson and explained the nature of today’s inspection.

It was alleged that staff did not maintain proper staff infant ratios.

During the course of the investigation, LPA conducted facility inspections on 06/03/2026, 06/16/2026, 07/14/2026, and 07/29/2026. During each visit, LPA toured the classroom and observed that the teacher to child ratio was in compliance. LPA also interviewed staff members, the director, the site supervisor and parents. In addition, LPA reviewed the Staffing Sheet and parents’ sign in and sign out sheets.

Based on interviews and evidence gathered, it is concluded that, while the allegation listed above may have occurred or may be valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4