304370845-3-25-2021-06-CC-JHAN-BZG5V3-20210325201648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304370845
Report Date: 03/25/2021
Date Signed: 03/25/2021 10:47:15 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2020 and conducted by Evaluator Cindy Nguyen

COMPLAINT CONTROL NUMBER: 06-CC-20201113093358

FACILITY NAME:	ACE MONTESSORI PRESCHOOL		FACILITY NUMBER:	304370845
ADMINISTRATOR:	PAL, DHARMENDRA		FACILITY TYPE:	850
ADDRESS:	24602 RAYMOND WAY SUITE #1		TELEPHONE:	(949) 735-2905
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	90	CENSUS: 12	DATE:	03/25/2021
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Director, Pal Dharmendra		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Daycare child sustained a fracture while in care.
Staff demonstrating inappropriate form of punishment towards daycare child.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced inspection for the purpose of delivering complaint findings for the complaint investigation that was conducted by Investigation Branch, Investigator Charlemagne and LPA Nguyen the above allegations. This is a continuation of the investigation initiated on 11/17/2020 & 11/18/2020. LPA met with Staff, Alyssa Obedoza. The Covid-19 Emergency Response risk questionnaires were asked. LPA toured the facility inside and outside. Census was taken as follow: 10 preschool children and 3 staff members. The final census was 12 children with 3 staff members. Director, Dharmendra Pal arrived shortly after the inspection.

During today's inspection staffing and capacity ratios were met. A review of staff criminal clearance records on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Continued on Page LIC 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

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 6

Control Number 06-CC-20201113093358

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ACE MONTESSORI PRESCHOOL	FACILITY NUMBER: 304370845
	VISIT DATE: 03/25/2021

NARRATIVE

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Page LIC 9099C Page 1

On 11/13/2020 a complaint was filed with the Licensing Office. Complainant alleged (1) daycare child sustained a fracture while in care, and (2) Staff demonstrating inappropriate form of punishment towards daycare child.

Regarding the first allegation, the complainant stated on 11/12/20, while Child #1 (C1) was in care, C1 had their finger caught in the door as a result of another child closing the door. At the time of pick up C1 had a bandage over the injury. After arriving home, the parent examined the finger and observed C1’s finger was swollen, skin was off, and C1 could barely move the finger. C1 was taken to urgent care be examined. After the examination and x-rays, it was determined that C1 had a fracture on the pinky finger. The facility didn’t notify the child’s parents until pick up time and an ouch report weren’t provided until the following day when the parent came to school to talked to the Director, Pal Dharmendra.

During the course of the investigation for allegation (1) daycare child sustained a fracture while in care, Investigator Charlemagne obtained medical records. C1 was diagnosed with an open displaced fracture of middle phalanx of left little finger as a result of a metal door approximately 6 feet, five inches in height and approximately 18 inches in length closed of child’s finger.

Additionally, Investigator Charlemagne interviewed staff, and director. During the interviews it was explained the there was one teacher and eleven children present. The children were transitioning from the play yard to the classroom. Child #7 (C7) was responsible for closing the door after all the children had entered the classroom. C7 closed the door catching C1’s finger. At the time of the incident, the teacher was inside the classroom, holding the hand of another child, and putting away supplies.

With regards to the second allegation, the Complainant also alleged staff at the facility demonstrate inappropriate form of punishment towards daycare child by locking Child #6 (C6) in a dark closet.

Continued Page LIC 9099C Page 2

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 06-CC-20201113093358

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ACE MONTESSORI PRESCHOOL	FACILITY NUMBER: 304370845
	VISIT DATE: 03/25/2021

NARRATIVE

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Page LIC 9099C Page 2

During the course of the investigation, Investigator Charlemagne interviewed staff, children, and parents and observed the physical classroom. Investigator Charlemagne noted that there was no closet in the facility, only storage cabinets. Staff interviewed stated there are 3 steps process when it comes to discipline, the first step is to distract the child, second step is to separate the child, third step is to have the child sit and think about, but rarely we have the children have to go to the third step. During the interview with Investigator Charlemagne, Staff 1 (S1) stated they do place students in the bathroom for punishment, and the length of time they spend in the bathroom equals to how old they are.

Children interviewed stated when children don’t listen, they go to time out in the bathroom, and they can't go out. Child #9 (C9) stated S1 puts children in the bathroom for punishment and she leaves them there for a long time. Child #8 (C8) stated children are in the bathroom for “a super long time.” Child #2 (C2) noted C6 yells and cries when put in the restroom and C6 says, “No, no.” C2 said when they put C6 in the restroom, S1 closes the door, so that C6 does not get out. Child #5 (C5) said S1 and Staff #4 (S4) put children outside and in the restroom as punishment. While in the restroom, the children just sit down in a chair and do nothing, and the door is open. C5 stated children are kept in the restroom for about five minutes as punishment. C5 said when children are in the restroom, S1 continues to teach the class and S1 also watches them. C5 noted, some students cry when they are placed in the restroom and some do not.

LPA interviewed parents. Parent #6 (P6) stated they understand of the discipline policy is time out, or something, but wasn’t sure of how long. Parent #7 (P7) stated the discipline policy at this facility is time-out and agreed with the policy. Overall, parents interviewed stated the facility is good and none expressed concerns about discipline.

Based on the investigation conducted by this agency, interviews were conducted with director, staff, children, C1s parent, current parents of children in care and, and in addition, staff timecard, children’s sign in/out, children’s roster, medical records, ouch report, discipline policy and pictures were reviewed. The preponderance of evidence standard has been met, the allegations of daycare child sustained a fracture while in care due to lack supervision and staff at the facility demonstrate inappropriate form of punishment towards daycare child are Substantiated. Due to a child in care sustaining an injury as a result of lack of supervision a civil penalty $150.00 is being assessed this date. Continued on Page LIC 9099C Page 3

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 06-CC-20201113093358

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ACE MONTESSORI PRESCHOOL	FACILITY NUMBER: 304370845
	VISIT DATE: 03/25/2021

NARRATIVE

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Page LIC 9099C Page 3

During the course of this investigation, it was learned that the facility failed to notify the licensing office that on 11/12/21 a child in care, sustained an injury that required medical treatment. The facility is required to report this incident to the Department within 24 hours.

The following violations are being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101229(a)(1) Care and Supervision; Section 101223(a)(3) Personal Rights; Section 101212(d) (1) (B) Reporting Requirements on the attached LIC 9099D.

This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 06-CC-20201113093358

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ACE MONTESSORI PRESCHOOL	FACILITY NUMBER: 304370845
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/25/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/26/2021 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision... children's needs. (1) No child(ren) shall be left without the supervision of a teacher... Supervision shall include visual observation. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Director will conduct a training for the staff in relation to Responsibility for Providing Care and Supervision and will watch the Department Training video related to Providing Care and Supervision on the Department website at www.ccld.ca.gov. A sign in sheet will be provided to the Department related to the training discussion and the attendees by the due date 3/26/21.
	8 9 10 11 12 13 14	Base on evidenced by the IB investigation substantiated a child in care fractured on the pinky finger as a result of the door being closed on the child finger. The occurred due to a lack of care and supervision. This posed an immediate risk to the health and safety of child in care.	8 9 10 11 12 13 14	A civil penalty, $150, is issued today as child sustained an injury due to violation.
Type A 03/26/2021 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive... functioning. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Director will conduct a training for the staff in relation to Personal Rights and will watch the Department Training video related to Personal Rights on Department website at www.ccld.ca.gov. A sign in sheet will be provided to the Department related to the training discussion and the attendees by the due date 3/26/21.
	8 9 10 11 12 13 14	Based on interviews, Staff 1 (S1) stated they do place students in the bathroom for punishment, and the length of time they spend in the bathroom equals to how old they are. This poses an immediate safety risk to children care.	8 9 10 11 12 13 14

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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 06-CC-20201113093358

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ACE MONTESSORI PRESCHOOL	FACILITY NUMBER: 304370845
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/25/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/26/2021 Section Cited CCR 101212(d)(1)(B)	1 2 3 4 5 6 7	Reporting Requirements. 101212 (d) Upon the occurrence, ... events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next workin day...rrence of such event. (1) Events reported shall include the following: (B) Any injury to any child that requires medical treatment. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	LPA provided the director with regulations 101212 Reporting Requirements and LIC 624. Director will sent a written LIC 624 regarding the incident to the licensing office by the due date 3/26/21.
	8 9 10 11 12 13 14	The facility failed to report the incident of child seeking for Urgent Care of a fracture on the pinky finger. This poses a potential safety 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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

LIC9099 (FAS) - (06/04)

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