197407586-2-24-2023-58-CC-KSTS-CPG2WN-20230227164548

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197407586
Report Date: 02/24/2023
Date Signed: 02/24/2023 01:09:12 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/29/2022 and conducted by Evaluator Doris Whitmore

PUBLIC

COMPLAINT CONTROL NUMBER: 58-CC-20221129104414

FACILITY NAME:	MONTESSORI OF CHATSWORTH		FACILITY NUMBER:	197407586
ADMINISTRATOR:	ERBE, ANNEROSE		FACILITY TYPE:	850
ADDRESS:	10616 ANDORA AVE.		TELEPHONE:	(818) 709-2980
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	110	CENSUS: 91	DATE:	02/24/2023
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Anna Erbe		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Allegation: Reporting Requirements

INVESTIGATION FINDINGS:

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On 02/24/2023 at 9:34a.m. Licensing Program Analyst ( LPA) Doris Whitmore conducted an unannounced complaint visit for the purpose of delivering the findings of the investigation regarding the allegation above. LPA met with Anna Erbe and observed ninety one children and eleven staff at the time of the visit. LPA interviewed five children from Room 7
On 01/26/2023 at 9:07 a.m. Licensing Program Analyst (LPA) Doris Whitmore conducted an unannounced complaint investigation and met with Director Anna Erbe for the purpose of continuing interviews with Director, Staff, and Children. LPA toured the facility and took pictures of room 7. LPA obtained the following documents Personel Record and two written statements from staff. At the time of the investigation LPA observed thirty-two children and four staff at the time of the visit.

On 12/06/2023 Licensing Prgram Anayst( LPA) Doris Whitmore initiated the complaint investigation and met with Director Anna Erbe. LPA toured the facility indoors and outdoors. LPA observed fifty-eight children and eight staff at the time of the visit. LPA conducted interviews with Director, Staff, and Children and obtained

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

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 58-CC-20221129104414

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI OF CHATSWORTH	FACILITY NUMBER: 197407586
	VISIT DATE: 02/24/2023

NARRATIVE

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Parent Handbook, Roster, Sick& Medication Policy, Emergency Card, Enrollment Checklist, Personnel Report, Daily Schedule, Sign in Sheets and Teacher Handbook.

Based on interviews staff admitted that the hot rice was accidentally spilled on the child, but the facility failed to notify the parent of the incident. Therefore , the allegations of reporting requirements is substantiated, meaning that the allegation is valid because the preponderance of the evidence standards has been met.

Deficiency cited LIC9099D and copy of report issued Notice of Site Visit and Appeal Rights given

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC9099 (FAS) - (06/04)

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Control Number 58-CC-20221129104414

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI OF CHATSWORTH	FACILITY NUMBER: 197407586
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/24/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/03/2023 Section Cited CCR 101212(d)(1)(C)	1 2 3 4 5 6 7	Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.	1 2 3 4 5 6 7	Have the staff view the videos on the website for Reporting Requirements and Personal Rights by 03/03/2023. sending to the LPA of what their take away is from the videos.www.ccld.ca.gov
	8 9 10 11 12 13 14	Events reported shall include the following: Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This is deemed evidence by LPA did not observe notification of the incident in the childs file	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: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC9099 (FAS) - (06/04)

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