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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073402889
Report Date: 08/26/2022
Date Signed: 08/26/2022 01:40:22 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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2022 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220824103916
FACILITY NAME:MONTESSORI SCHOOL OF CONCORDFACILITY NUMBER:
073402889
ADMINISTRATOR:METROCK, ANAFACILITY TYPE:
850
ADDRESS:3039 WILLOW PASS ROADTELEPHONE:
(925) 682-8067
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:56CENSUS: 26DATE:
08/26/2022
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ana Delmy MetrockTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
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7
8
9
Building & Grounds - Diaper changing table is not being kept clean and sanitary for children in care
INVESTIGATION FINDINGS:
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5
6
7
8
9
10
11
12
13
On 8/26/22 at 8:15 am Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Subsequent Complaint Investigation at Montessori School of Concord. LPA met with Licensee/Director, Ana Delmy Metrock and explained purpose of investigation.
Complainant alleges that diaper changing table is not being cleaned or sanitary. During the course of the investigation, LPA inspected the facility, made observations, reviewed records and conducted interviews. LPA observed the changing pad was covered with a cloth towel. Staff S1 did not change the towel or sanitize the pad in between diaper changes. Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.
Exit interview was conducted with Licensee/Director, Ana Delmy Metrock.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
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 6
Control Number 02-CC-20220824103916
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI SCHOOL OF CONCORD
FACILITY NUMBER: 073402889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2022
Section Cited
CCR
101238(a)
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3
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5
6
7
101238 Building & Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
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7
Licensee agreed to dispose off the towel cover on the changing pad immediately and use a disposable product or clean and sanitize the pad after each use. By POC Due Date 8/29/22 Director shall submit in writing how they plan to stay in compliance with this regulation, especially with diapering procedures.
8
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Per observations, Staff S1 did not change the towel on the changing pad or sanitize the towel or pad in between two diaper changes. This is a potential risk to health and safety of children.
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14
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2022 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220824103916

FACILITY NAME:MONTESSORI SCHOOL OF CONCORDFACILITY NUMBER:
073402889
ADMINISTRATOR:METROCK, ANAFACILITY TYPE:
850
ADDRESS:3039 WILLOW PASS ROADTELEPHONE:
(925) 682-8067
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:56CENSUS: DATE:
08/26/2022
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ana Delmy MetrockTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Out of ratio
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/26/22 at 8:15 am Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Subsequent Complaint Investigation at Montessori School of Concord. LPA met with Licensee/Director, Ana Delmy Metrock and explained purpose of investigation.
Complainant alleges that classroom has been out of ratio.
During the course of the investigation, LPA inspected the facility, made observations, reviewed records and conducted interviews. LPA observed during morning drop off S2 had 14 children by herself for about 10 minutes before additional staff arrived at 9 am. Director was in another room with 12 children.
Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.
Exit interview was conducted with Licensee/Director, Ana Delmy Metrock.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
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 6
Control Number 02-CC-20220824103916
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI SCHOOL OF CONCORD
FACILITY NUMBER: 073402889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2022
Section Cited
CCR
101216.3(a)
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7
101216.3(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance [...]. This requirement is not met as evidenced by:
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7
By POC Due Date 8/29/22 Licensee agreed to submit a written plan on how center will stay in compliance with this regulation.
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9
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12
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14
Per observation, during morning drop off S2 had 14 children by herself for about 10 minutes before additional staff arrived at 9 am. Director was in another room with 12 children. This is a potential risk to health, safety of children in care.
8
9
10
11
12
13
14
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2
3
4
5
6
7
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2
3
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5
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2022 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220824103916

FACILITY NAME:MONTESSORI SCHOOL OF CONCORDFACILITY NUMBER:
073402889
ADMINISTRATOR:METROCK, ANAFACILITY TYPE:
850
ADDRESS:3039 WILLOW PASS ROADTELEPHONE:
(925) 682-8067
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:56CENSUS: 26DATE:
08/26/2022
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ana Delmy MetrockTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Responsibility for Providing Care & Supervision: Children left unattended in classroom
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/26/22 at 8:15 am Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Subsequent Complaint Investigation at Montessori School of Concord. LPA met with Licensee/Director, Ana Delmy Metrock and explained purpose of investigation.
Complainant alleges children are left unattended in classroom.
During the course of the investigation, LPA inspected the facility, made observations, reviewed records and conducted interviews. LPA observed while S1 greeted a parent at the door, a child who was ready to be changed, walked back to the adjacent changing room, climbed up a step ladder and sat on the changing pad waiting for S1 to come. S1 was unaware child had walked away and was alone for about 1-2 minutes.
Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.
Exit interview was conducted with Licensee/Director, Ana Delmy Metrock.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
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 6
Control Number 02-CC-20220824103916
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI SCHOOL OF CONCORD
FACILITY NUMBER: 073402889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2022
Section Cited
CCR
101229(a)(1)
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2
3
4
5
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7
101229 Responsibility for Providing Care & Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time [...] This requirement is not met as evidenced by:
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By POC Due Date 8/29/22 Licensee agreed to
1. submit a written plan on how facility will stay in compliance providing visual supervision at all times.
2. By 9/2/22 Conduct all staff training, watch video on supervision on CCLD website. Submit verification of training.
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LPA observed while S1 greeted a parent at the door, a child who was ready to be changed, walked back to adjacent changing room, climbed a step ladder, sat on changing pad waiting for S1 who was unaware child was alone for about 1-2 minutes. This is a potential risk to safety of children in care.
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9
10
11
12
13
14
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2
3
4
5
6
7
1
2
3
4
5
6
7
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6