198017089-9-2-2022-33-CC-CGUA-CJLRAD-20220925125058

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198017089
Report Date: 09/02/2022
Date Signed: 09/02/2022 02:17:18 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2022 and conducted by Evaluator Seung Lee

COMPLAINT CONTROL NUMBER: 33-CC-20220815162448

FACILITY NAME:	LITTLE ACORN MONTESSORI ACADEMY		FACILITY NUMBER:	198017089
ADMINISTRATOR:	SUSIE SAYEAH		FACILITY TYPE:	850
ADDRESS:	1957 W. HUNTINGTON DR.		TELEPHONE:	(626) 289-2873
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	92	CENSUS: 66	DATE:	09/02/2022
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Susie Maroulakis		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff provided inappropriate snack to a child with allergies

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Seung Lee conducted an unannounced complaint inspection. Upon arrival LPA Lee met with Director Susie Maroulakis.

During the course of this investigation, LPA Lee conducted interviews, reviewed documents, and made observations in regards to the above allegation.

The complaint stated that on 08/15/2022 Child#1 consumed a snack that she was allergic to. Child#1 brings her own meals and snacks to the facility, and the child is also noted in an allergy list posted in the classroom and in the food preparation area. The Director stated that Child#1 was given a snack from the classroom teacher by mistake. After it was observed that Child#1 was breaking out in a rash after eating the snack, the facility contacted the parent of Child#1. The parents arrived at the facility and administered some allergy medication to Child#1 and took the child back home.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Guangorena Claudia	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022

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 3

Control Number 33-CC-20220815162448

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LITTLE ACORN MONTESSORI ACADEMY	FACILITY NUMBER: 198017089
	VISIT DATE: 09/02/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The Director stated that the facility does have a incidental medical plan for Child#1's Epi-Pen, but it was not used based on the observations made by the facility. The Director stated that she has already met with the parents of Child#1 to make sure the medication used during the incident is physically at the facility for any future use.

Since the facility was aware of Child#1's special dietary needs prior to the incident on 08/15/2022, the child being fed food she was allergic to by the facility and not the snack that was brought from home was an immediate risk to the child in care.

Based on the information obtained during the investigation, the preponderance of evidence standard has been met, therefore the allegation that facility Staff provided inappropriate snack to a child with allergies is substantiated. California Code of Regulations,(Title 22, Division 12 & Chapter Number 6), is being cited on the attached LIC 9099D.

Facility was advised that the form LIC 9224 will need to provided to all enrolled and future parents of children in care for 1 year from the date of this report.

The notice of site inspection along with all pages of this report must remain posted for a period of 30 days during business hours. Failure to maintain posting during business hours will result in a civil penalty of $100.00 dollars.

Exit interview conducted with Director Susie Maroulakis. Appeal rights discussed and explained.

SUPERVISOR'S NAME: Guangorena Claudia	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 33-CC-20220815162448

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LITTLE ACORN MONTESSORI ACADEMY	FACILITY NUMBER: 198017089
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/02/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/02/2022 Section Cited CCR 101227(7)(B)	1 2 3 4 5 6 7	Food Services Modified diets prescribed by a child's physician as a medical necessity shall be provided. child shall not be served any food to which the child's record indicates he/she has an allergy. This requirement was not met as evidenced by the fact that Child#1 was fed	1 2 3 4 5 6 7	The Director stated that she has met with all the staff of the facility to ensure that children's special dietary needs are verified prior to providing meals and snacks at the facility. Additional training on this topic was also conducted for all staff from 08/29-09/01 per Director.
	8 9 10 11 12 13 14	a snack she was allergic to despite having Child#1's dietary needs posted in the classroom and the food preparation area. This is an immediete risk to 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: Guangorena Claudia	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3