197419166-4-1-2022-12-CC-MRAN-CD8TYS-20220406150915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197419166
Report Date: 04/01/2022
Date Signed: 04/01/2022 02:03:55 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
01/12/2022 and conducted by Evaluator Monique Jessica Ayala

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20220112125216

FACILITY NAME:	MONTESSORI OF STEVENSON RANCH		FACILITY NUMBER:	197419166
ADMINISTRATOR:	ELLISON, DESIREE		FACILITY TYPE:	850
ADDRESS:	25940 THE OLD ROAD		TELEPHONE:	(661) 257-4161
CITY:	STEVENSON RANCH	STATE: CA	ZIP CODE:	91381
CAPACITY:	188	CENSUS: 95	DATE:	04/01/2022
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Michelle Parmaro, Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Personal Rights: Daycare child sustained unexplained injury while in
Lack of Supervision: Daycare child swallowed foreign object while in care.

INVESTIGATION FINDINGS:

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On April 1, 2022 Licensing Program Analyst (LPA) Monique Ayala conducted an unannouced complinat investigation to deliver findings of the above allegations. LPA was greeted by director who guided LPA on a tour of the facility. LPA observed 95 children with 15 staff members.

During this investigation, LPA interviwed staff, children, and other relevant complaint parties and also reviewed video footage. Based on the information obtained and interviews conducted the allegation is deemed Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged occurred.

An exit interview was conducted and a copy of this report was provded to the director along with Appeal Rights and Notice of Site Visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica Ayala	TELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022

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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