010213903-7-30-2021-52-CC-JJAG-C8GMZS-20211105100338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 010213903
Report Date: 07/30/2021
Date Signed: 07/30/2021 04:01:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/24/2021 and conducted by Evaluator Jabari Wilson

PUBLIC

COMPLAINT CONTROL NUMBER: 52-CC-20210624152130

FACILITY NAME:	MONTESSORI SCHOOL AT WASHINGTON AVENUE		FACILITY NUMBER:	010213903
ADMINISTRATOR:	MIRIAM YOUSSEF		FACILITY TYPE:	850
ADDRESS:	14795 WASHINGTON AVENUE		TELEPHONE:	(510) 357-8432
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94578
CAPACITY:	111	CENSUS: 77	DATE:	07/30/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Mirian Youssef		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff not providing adequate supervision to children in care

INVESTIGATION FINDINGS:

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On 07/30/2021 Licensing Program Analyst (LPA) Jabari Wilson conducted an unannounced subsequent complaint investigation at the facility. LPA met with Director Mirian Youssef and explained the purpose of today’s inspection. The finding for the above allegation was delivered during the visit.

During the investigation the department completed a physical plant inspection, reviewed facility records, and conducted interviews. LPA interviews with staff determined there was not enough evidence to support that staff is not providing adequate supervision to children in care. LPA conducted an interview with RP who indicated her child was inappropriately touched by another child in care. RP also indicated that her child sustatained minor injuries on the playground which were not seen or reported by the facility. Based on the interviews and information obtained throughout the investigation, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation occurred, therefore the allegation is deemed UNSUBSTANTIATED.

The director was provided a copy of this report and appeal rights, and the signature on this form acknowledges receipts of these rights. An exit interview was conducted with Director Mirian Youssef and Notice of Site visit was provided and posted on the wall.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Jabari Wilson	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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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