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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415899
Report Date: 07/20/2022
Date Signed: 07/20/2022 02:12:10 PM

Substantiated


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
04/14/2022 and conducted by Evaluator Deanna Villagrana
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220414123453
FACILITY NAME:LAZO SAMANIEGO, HERMITA ANAFACILITY NUMBER:
434415899
ADMINISTRATOR:HERMITA ANA LAZO SAMANIEGOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 416-6916
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 8DATE:
07/20/2022
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Hermita Ana Lazo SamaniegoTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Licensee is operating over capacity.
Licensee mistreats daycare children.
Licensee does not provide adequate supervision for the children in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Hermita Ana Lazo Samaniego to deliver findings for above allegations. Present were licensee, licensee's three assistants Shirley Rodriguez, Madelyn Martinez and Suly Ortiz with eight children including two infants.

Based on the allegations and the time frame the incidents occurred (approximately three years prior), these allegations were previously cited on a complaint and case management report dated 04/05/2022. Therefore citations were already issued. No other citations were issued during visit.

A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
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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