013416606-12-8-2023-52-CC-CCHS-CYJMG6-20231215083521

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013416606
Report Date: 12/08/2023
Date Signed: 12/08/2023 01:39:10 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 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
11/01/2023 and conducted by Evaluator Christina Uribe

PUBLIC

COMPLAINT CONTROL NUMBER: 52-CC-20231101084940

FACILITY NAME:	MONTESSORI SCHOOL AT FIVE CANYONS		FACILITY NUMBER:	013416606
ADMINISTRATOR:	VAN GROENOU, MEHER		FACILITY TYPE:	850
ADDRESS:	22781 CANYON COURT		TELEPHONE:	(510) 581-3729
CITY:	CASTRO VALLEY	STATE: CA	ZIP CODE:	94552
CAPACITY:	120	CENSUS: 74	DATE:	12/08/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Martha Sanchez		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not keep accurate sign-in/out records

INVESTIGATION FINDINGS:

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On 12/08/2023 at 12:30pm, Licensing Program Analyst (LPA) Christina Uribe conducted an unannounced visit for the purpose of investigating a complaint regarding the above allegation of a record keeping violation and met with director, Martha Sanchez. Also present at the time of today’s inspection are 74 children and 12 staff.

Based on evidence received which was reviewed, the preponderance of evidence standard has been met, therefore the above allegation that the staff do no tkeep accurate sign in/out records is SUBSTANTIATED.California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 101229.1(a)(1) - Sign In and Sign Out is being cited on the attached LIC 9099D.

Report was reviewed and a notice of site visit was given and must remain posted for 30 days. Appeal rights were given. Exit interview was conducted with director, Martha Sanchez.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina Uribe	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

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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Control Number 52-CC-20231101084940

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI SCHOOL AT FIVE CANYONS	FACILITY NUMBER: 013416606
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/08/2024 Section Cited CCR 101229.1(b)	1 2 3 4 5 6 7	Section 101229.1(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement was not met as evidenced by: During record review and interviews, LPA found sign in and out records were not	1 2 3 4 5 6 7	Director will create a written plan for how the facility will ensure that all children are signed in and out appropriately to reflect exactly who dropped off or picked up the child each day. Written statement will be emailed to LPA Uribe at christina.uribe@dss.ca.gov no later than the due date of 01/08/2024.
	8 9 10 11 12 13 14	accurate as some children were not signed out for a day, some children were signed out by the admin staff, and one child's authorized pick up person was using the wrong access code to sign the child out all of which poses a potential risk to the health, safety, and personal rights to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina Uribe	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

LIC9099 (FAS) - (06/04)

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