197417397-3-13-2020-12-CC-MRAN-BMP2K5-20200313172720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197417397
Report Date: 03/11/2020
Date Signed: 03/13/2020 05:14:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/16/2019 and conducted by Evaluator Lady King

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20191216161300

FACILITY NAME:	MONTESSORI OF VALENCIA		FACILITY NUMBER:	197417397
ADMINISTRATOR:	ERIN JOHNSON		FACILITY TYPE:	830
ADDRESS:	24925 ANZA DRIVE		TELEPHONE:	(661) 257-4161
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY:	24	CENSUS:	DATE:	03/11/2020
		UNANNOUNCED	TIME BEGAN:	12:03 PM
MET WITH:	Erin Johnson, Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Personal Rights- Child sustained injury while in care

INVESTIGATION FINDINGS:

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On March 11, 2020, Licensing Program Analyst (LPA) King conducted a subsequent complaint investigation for the purpose of conclude the investigation for the above allegation. Upon arrival, LPA was greeted by the director, Erin Johnson.

The investigation consisted of interviews with staff, director, and review of medical records. Based on the evidence obtained, it has been determined a violation of personal rights is substantiated based on evidence that infant #1 sustained burns to his face, neck and shoulder. Staff #1 failed to ensure the safety of the immediate area around her when staff #1 removed hot water from a microwave and infant #1 ran into staff #1’s leg causing her to lose her balance resulting in the container of hot water spilling on infant #1’s left side of his face, neck and shoulder. Proper emergency treatment was administered, and infant #1 was transported to the burn center for treatment.

Please see Complaint Investigation LIC 9099C for additional information.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Mariela Ramon	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020

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 12-CC-20191216161300

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MONTESSORI OF VALENCIA	FACILITY NUMBER: 197417397
	VISIT DATE: 03/11/2020

NARRATIVE

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The facility was cited Type A deficiency according to the California Code Title 22 Regulations including an immediate civil penalty assessment due to the child sustaining an injury. See Facility Evaluation Report LIC 9099D for deficiency.

Upon receipt of a Type A deficiency the center shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility currently and must be provided to parents/guardians of children newly enrolled children at the facility during the next 12 months, obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian, to be placed it in each child's file. If these requirements are not met, civil penalties will be assessed.

An exit interview conducted, appeal rights discussed, and a copy of this report was provided to Director.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020

LIC9099 (FAS) - (06/04)

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Control Number 12-CC-20191216161300

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MONTESSORI OF VALENCIA	FACILITY NUMBER: 197417397
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/20/2020 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	Personal Rights- The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidence by: Staff #1 failed to ensure the	1 2 3 4 5 6 7	Director submitted a written plan of correction stating all bottles are heated in the adjoining infant room to be heated. The bottle is then retuned to the classroom and to the child. Furthermore, children may only transfer into this room when they are on a sippy cup, or do not require a bottle to be heated. POC cleared.
	8 9 10 11 12 13 14	safety of the immediate area around her when staff #1 removed hot water from a microwave and infant #1 ran into staff #1’s leg causing her to lose her balance resulting in the container of hot water spilling on infant #1’s left side of his face, neck and shoulder. This is a type A deficiency as it poses immediate hazard to health and safety of 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: Scott Herring	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Mariela Ramon	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020

LIC9099 (FAS) - (06/04)

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