304370845-3-25-2021-06-CC-JHAN-BZM2EV-20210330172030

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304370845
Report Date: 03/25/2021
Date Signed: 03/25/2021 10:58:19 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
03/19/2021 and conducted by Evaluator Cindy Nguyen

COMPLAINT CONTROL NUMBER: 06-CC-20210319154838

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:	10:45 AM
MET WITH:	Director, Pal Dharmendra		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Uneven pavement caused child to trip.

INVESTIGATION FINDINGS:

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A complaint inspection was conducted on this date by Licensing Program Analyst (LPA) Nguyen. Met with the Director, Dharmendra Pal and informed the above allegation. Census was taken as follow: 10 preschool children and 3 staff members. The final census was 12 children with 3 staff members. LPA toured the facility inside and outside. During today's inspection staffing and capacity ratios were met. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

On 03/19/21 a complaint was filed with the Licensing Office. Complainant alleged the facility outdoor activity space has tripping hazard due to the uneven pavement.

Continued on Page 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 3

Control Number 06-CC-20210319154838

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 9099C

Based on LPA observations and the inspection of the outdoor activity space, the pavement near the playground has uneven pavement causing a tripping hazard. Director stated the roots of the big tree is causing the pavement to be uneven. LPA observed the uneven pavement from the lunch area to the playground has been fixed however some of the areas near the tree to the cement area are also uneven and can cause tripping hazards. LPA took pictures of the tripping hazards. The facility failed to ensure the surface of the outdoor activity space shall be maintained in a safe condition for the activities planned and free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. The preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. California Code of Regulations, Title 22 101238.2 (d)(1)(2) is being cited on the attached LIC 9099D

Exit interview was conducted with Director, Pal Dharmendra. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The director/licensee was provided a copy of their appeal rights (LIC 9058 12/16) and their signature on this form acknowledges receipt of these rights.

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 3

Control Number 06-CC-20210319154838

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 03/31/2021 Section Cited CCR 101238.2(d)(1)(2)	1 2 3 4 5 6 7	Outdoor Activity Space (d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned. (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Director agrees to submit pictures of correction to CCL by due date 3/31/21.
	8 9 10 11 12 13 14	Based on observation, inspection of the outdoor activity space and interview with director, the director failed to maintain a safe condition for the activities planned. This poses a potential safety risk to the 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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