013420938-9-1-2022-52-CC-CCHS-CK3M3U-20221010091545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013420938
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:49:44 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
07/22/2022 and conducted by Evaluator April Wright

COMPLAINT CONTROL NUMBER: 52-CC-20220722134832

FACILITY NAME:	EMPIRE MONTESSORI PRESCHOOL		FACILITY NUMBER:	013420938
ADMINISTRATOR:	SHIMEI YANG		FACILITY TYPE:	850
ADDRESS:	3765 WASHINGTON BLVD		TELEPHONE:	(510) 979-1696
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY:	120	CENSUS: 39	DATE:	09/01/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	July Grace Galaraga		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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.Reporting Requirements - Uncleared staff working at the facility

INVESTIGATION FINDINGS:

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On September 1st, 2022 at approximately 9:45am Licensing Program Manager (LPM) Chandra Charles and Licensing Program Analyst (LPA) April Wright met with July Grace Galaraga, Center Director and owner Shimei Yang for an unannounced follow-up complaint inspection. The purpose of the inspection is to deliver the complaint investigation findings. During today's inspection there was 39 preschoolers and 7 staff personnel present. All staff personnel have fingerprint clearance. A health and safety inspection was conducted by the LPA and the LPM.
During the course of the investigation LPA conducted file reviews of staff files, facilty file and interviewed staff. LPA observed that the Center Directors file was not filed with CCLD and was incomplete.

This agency has investigated this complaint alleging - Uncleared staff working at the facility. Based on LPAs observations, file review and interviews which were conducted and the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
See 9099-D

Exit Interview conducted with Center Director July Grace Galaraga, report and appeal rights given.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April Wright	TELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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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Control Number 52-CC-20220722134832

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: EMPIRE MONTESSORI PRESCHOOL	FACILITY NUMBER: 013420938
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/01/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B CCR	1 2 3 4 5 6 7	The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s). It was reported to Licensing that there has been a director change and not reported to licensing department	1 2 3 4 5 6 7	Corrected before and during visit.
	8 9 10 11 12 13 14	Based on an anonymous letter received by licensing, it was revealed that a change of director had not been reported to licensing. Directorship was changed on May 16, 2022. Licensing was advised by anonymous letter on August 2022.	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: April Wright	TELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

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