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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010213903
Report Date: 03/08/2023
Date Signed: 03/14/2023 12:29:06 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, 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
02/22/2023 and conducted by Evaluator Christina Uribe
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20230222154635
FACILITY NAME:MONTESSORI SCHOOL AT WASHINGTON AVENUEFACILITY NUMBER:
010213903
ADMINISTRATOR:YOUSSEF, MARIANFACILITY TYPE:
850
ADDRESS:14795 WASHINGTON AVENUETELEPHONE:
(510) 357-8432
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:111CENSUS: 64DATE:
03/08/2023
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Pamela RiggTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Lack of Supervision - Staff's lack of supervision resulted in child choking on an object
INVESTIGATION FINDINGS:
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On 03/08/2023 at 12:30pm, Licensing Program Analyst (LPA) Christina Uribe and Licensing Program Manager (LPM) Chandra Charles conducted an unannounced visit for the purpose of investigating a complaint for the above allegation of lack of supervision and met with the licensee, Pamela Rigg. At the time of the visit there are 64 children and 11 staff present.

Based on LPA’s interviews which were conducted and recorded, the preponderance of evidence standard has been met, therefore the above allegation of staff's lack of supervision resulted in child choking on an object is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division12, Chapter 1, Section 101229(a)(1), is being cited as a Type B Violation on the attached LIC 9099D form.

A notice of site visit was given and must remain posted for 30 days. Copy of appeal rights and report was given. Exit interview was conducted with the licensee, Pamela Rigg.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
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 7
Control Number 52-CC-20230222154635
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI SCHOOL AT WASHINGTON AVENUE
FACILITY NUMBER: 010213903
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2023
Section Cited
CCR
101229(a)(1)
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Title 22, Division 12, Chapter 1, Section 101229(a)(1) No child(ren) shall be left without the supervision of a teacher at any time. Supervision shall include visual supervision.

This regulation is not met as evidenced by:
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Licensee will hold a staff meeting and review safety protocols for supervision and choking hazards for children. Licensee will create a written statement which states the safety protocols and guidelines for supervising children in care. Each staff member will sign and date this written statement
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The facility did not ensure proper supervision resulting in a child swallowing then choking a penny coin, which enduced vomitting which poses a potential health, safety, or personal rights risk to children in care.
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Once signed by all staff, licensee will email this written statement to LPA Uribe at christina.uribe@dss.ca.gov no later than the due date of 04/07/2023.
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
02/22/2023 and conducted by Evaluator Christina Uribe
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20230222154635

FACILITY NAME:MONTESSORI SCHOOL AT WASHINGTON AVENUEFACILITY NUMBER:
010213903
ADMINISTRATOR:YOUSSEF, MARIANFACILITY TYPE:
850
ADDRESS:14795 WASHINGTON AVENUETELEPHONE:
(510) 357-8432
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:86CENSUS: 64DATE:
03/08/2023
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Pamela RIggTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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9
Qualifications - Facility does not have a director
INVESTIGATION FINDINGS:
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On 03/08/2023 at 12:30pm, Licensing Program Analyst (LPA) Christina Uribe and Licensing Program Manager (LPM) Chandra Charles conducted an unannounced visit for the purpose of investigating a complaint for the above allegation of qualifications violation and met with the licensee, Pamela Rigg. At the time of the visit there are 64 children and 11 staff present.

Based on LPA’s record review and interviews which were conducted and recorded, the preponderance of evidence standard has been met, therefore the above allegation of the facility does not have a director is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division12, Chapter 1, Section 101212(b), is being cited as a Type B Violation on the attached LIC 9099D form.

A notice of site visit was given and must remain posted for 30 days. Copy of appeal rights and report was given. Exit interview was conducted with the licensee, Pamela Rigg.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 52-CC-20230222154635
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI SCHOOL AT WASHINGTON AVENUE
FACILITY NUMBER: 010213903
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2023
Section Cited
CCR
101212(b)
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Title 22, Division 12, Chapter 1, Section 101212(b) The name of the child care center director shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This regulation is not met as evidenced by:
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The licensee will have the new director complete the Mandated Reporter Training for Child Care Providers (AB 1207), Operations & Record Keeping Orientation, and Preventative Health & Safety Training. These certificates are needed in order to qualify Jungok "Rose" Hwang as the
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The licensee did report a change of director to CCLD until after the first 10 days since the previous director ended employment and the replacement does not qualify as a director which poses a potential health, safety, or personal rights risk to children in care.
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center director. The licensee will email all complete certicates for the trainings listed above to LPA Uribe at christina.uribe@dss.ca.gov no later than the due date of 04/07/2023.
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7
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
02/22/2023 and conducted by Evaluator Christina Uribe
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20230222154635

FACILITY NAME:MONTESSORI SCHOOL AT WASHINGTON AVENUEFACILITY NUMBER:
010213903
ADMINISTRATOR:YOUSSEF, MARIANFACILITY TYPE:
850
ADDRESS:14795 WASHINGTON AVENUETELEPHONE:
(510) 357-8432
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:86CENSUS: 64DATE:
03/08/2023
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Pamela RiggTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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9
Ratio - Facility is operating out of ratio
INVESTIGATION FINDINGS:
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On 03/08/2023 at 12:30pm, Licensing Program Analyst (LPA) Christina Uribe and Licensing Program Manager (LPM) Chandra Charles conducted an unannounced visit for the purpose of investigating a complaint for the above allegation of ratio violation and met with the licensee, Pamela Rigg. At the time of the visit there are 64 children and 11 staff present.

Based on LPA’s observation, record review, & interviews which were conducted and recorded, the preponderance of evidence standard has been met, therefore the above allegation of the facility is operating out of ratio is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division12, Chapter 1, Section 101216.3(a), is being cited as a Type A Violation on the attached LIC 9099D form.


Page 1 of 2 ***Continued on LIC 9099C***
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 52-CC-20230222154635
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI SCHOOL AT WASHINGTON AVENUE
FACILITY NUMBER: 010213903
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/09/2023
Section Cited
CCR
101216.3(a)
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Title 22, Division 12, Chapter 1, Section 101216.3(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance.

This regulation is not met as evidenced by:
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Licensee and employees will watch the training video "Teacher-to-Child Ratios in Child Care Centers" on the CCLD website. Licensee will create a written statement detailing the facility's responsibility for maintaining teacher-to-child ratio and a plan of action for how the facility will follow these
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The facility did not that a ratio of one fully qualified teacher to 12 children is being followed at all times which poses an immediate health, safety, or personal rights risk to children in care.
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 requirements at all times. This written statement will be signed and dated by the licensee and all staff members. Once signed and completed, the licensee will email this written statement to LPA Uribe at christina.uribe@dss.ca.gov no later than the deadline of 6pm on 03/09/2023.
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 52-CC-20230222154635
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTESSORI SCHOOL AT WASHINGTON AVENUE
FACILITY NUMBER: 010213903
VISIT DATE: 03/08/2023
NARRATIVE
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LPA Uribe informed the licensee, Pamela Rigg, that this report dated 03/08/2023 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Uribe informed the licensee to provide a copy of this licensing report dated 03/08/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Copy of appeal rights and report was given. Exit interview was conducted with the licensee, Pamela Rigg.

















Page 2 of 2
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7