<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 213004840
Report Date: 04/21/2022
Date Signed: 04/21/2022 02:11:08 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/17/2022 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220217082254
FACILITY NAME:ABBEY MONTESSORI CHILDREN'S CENTER - PRESCHOOLFACILITY NUMBER:
213004840
ADMINISTRATOR:COSTELO, ELIZABETHFACILITY TYPE:
850
ADDRESS:138 N. SAN PEDRO ROADTELEPHONE:
(415) 479-8865
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:30CENSUS: 25DATE:
04/21/2022
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Lourdes AncaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not meet child's diapering needs
Child sustained unexplained injury while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 4/21/2022 at 9:10A.M., Licensing Program Analyst (LPA) Luis J. Gomez met with Lead Teacher, Lourdes Anca. Purpose of the inspection was explained and was for unannounced complaint investigation and to report the findings. Present was the Lead Teacher and 2 staff supervising 25 children. All children present had been properly signed in. LPA inspected facility, inside and outside, with lead teacher for health and safety hazards.

During inspection, LPA performed site observations, interviewed staff and reviewed facility records. During inspection, deficiencies were observed by LPA and cited on case management report (LIC809).

During the course of the investigation, observations were conducted on 2/24/2022 and 4/21/2022. A review of the facility records was completed, which included the children’s files, staff files and parent handbook. LPA conducted interviews with the director/ teacher, staff, sample of parents and all involved parties. (REFER TO LIC9099C, FOR CONT.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
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 2
Control Number 05-CC-20220217082254
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ABBEY MONTESSORI CHILDREN'S CENTER - PRESCHOOL
FACILITY NUMBER: 213004840
VISIT DATE: 04/21/2022
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
(Page 2)

Regarding the allegation of child sustained unexplained injury while in care; Based on interviews and evidence collected, LPA was unable to determine if day-care child sustained injury while in care. Parent handbook states that when injuries occur, first aid is applied, and child’s authorized representatives are informed.

Regarding the allegation of staff did not meet child's diapering needs; Based on interviews with staff and record review, LPA was unable to determine if staff did not meet child’s diapering needs. Based on interviews, it was reported that children's diapers are reviewed and changing by staff as needed.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

LPA conducted exit interview with the Lead Teacher. Report was explained and Notice of Site Visit was posted during inspection.

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2