304370996-6-11-2020-06-CC-BMAS-BQML6N-20200616082858

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304370996
Report Date: 06/10/2020
Date Signed: 06/11/2020 10:24:33 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
01/31/2020 and conducted by Evaluator Thuy Ho

COMPLAINT CONTROL NUMBER: 06-CC-20200131151811

FACILITY NAME:	FUTURE MINDS MONTESSORI		FACILITY NUMBER:	304370996
ADMINISTRATOR:	SALGADO, SIRANGI & SHIRAN		FACILITY TYPE:	850
ADDRESS:	408 S. FLOWER AVENUE		TELEPHONE:	(714) 309-0946
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY:	44	CENSUS: 8	DATE:	06/10/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Director Sirangi Salgado		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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A Child received burn while in care

INVESTIGATION FINDINGS:

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****This is an electronic version of a word document completed on 06/10/2020.***
Licensing Program Manager (LPM) Ho visited this facility to deliver the finding of an investigation conducted by an Investigations Branch (IB) Investigator, Lucius Charlemagne. An allegation of a child received burn while in care, was received in the licensing office. Upon today's arrival census was taken. There were 8 children in care with 2 attending staff.
During the investigation IB investigator, Charlemagne interviewed three staff members including the director, children, medical professional whom provided treatment to the child, and the authorized representative. IB Investigator reviewed and obtained the following: staff & children records, and medical reports. Pictures of the child’s injury along with the microwave location were also taken.
IB Investigator interviewed Staff #1 whom stated that on 01/22/2020 at around 11:15am, Staff #1 heated the child’s lunch, a cup of ramen noodle. Staff had never heated a ramen soup before. Staff #1 heated the soup for two minutes in the microwave. IB investigator noted that on the soup container, it states, “Do not microwave the soup.” Staff #1 then took the soup and walked the (6) day-care children to their seats in their

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bertha Manzanares	TELEPHONE: (714) 703-2805
LICENSING EVALUATOR NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

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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Control Number 06-CC-20200131151811

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: FUTURE MINDS MONTESSORI	FACILITY NUMBER: 304370996
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/10/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/10/2020 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229(a)(1) Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. No child shall be left without the supervision of a teacher at any time, … . Supervision shall include visual observation. This regulation is not met as evidenced by: Based on IB investigation, Staff #1 failed to provide care and supervision in the fact Staff #1 heated a	1 2 3 4 5 6 7	A civil penalty, $500.00, is issued today as child sustained an injury. Director stated the facility changed fodd service policy as of 2/26/20. Facility will not cook any food anymore. On 2/5/20, all staff members were trained on children's Health, Safety, and Supervision.
	8 9 10 11 12 13 14	very hot soup and placed it in an unsafe location and it was accessible to Child #1 resulting Child #1 spilled the hot soup and received a 2nd degree burn on the left leg. This lack of care and supervision posed an immediate risk to the safety of the child 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: Bertha Manzanares	TELEPHONE: (714) 703-2805
LICENSING EVALUATOR NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20200131151811

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: FUTURE MINDS MONTESSORI	FACILITY NUMBER: 304370996
	VISIT DATE: 06/10/2020

NARRATIVE

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classroom. Staff #1 placed the soup on the bookshelf in the classroom and told Child #1 not to touch the soup because it was hot. Staff #1 walked to the adjourning room with the day-care children and started to put the placemats down. Staff #1 placed a placemat in front of Child #2 as Staff #1 turned away from the children. Suddenly, Staff #1 heard Child #1 cry and scream and noticed the soup had spilled onto the Child #1’s left leg.

IB Investigator interviewed children; Child #1 statement where inconsistent regarding whether Staff #1 informed the child not to touch the soup. However, Child #1 indicated the soup was placed on the desk. Child #2 stated observed soup was on the edge of Child #1 desk when it fell on Child #1 leg/knee.

Staff #1 was negligent in the fact Staff #1 heated a very hot soup and placed in an unsafe location and it was accessed by Child #1 and Child #1 sustained a burn.

Based on the IB investigation, the preponderance of evidence standard has been met, therefore the allegation, a child received burn while in care, is substantiated. California Code of Regulations, Title 22, Division 12 Chapter 1 101229(a)(1) Care and Supervision is being cited on the attached deficiency page. Due to lack of supervision resulting in a child sustaining an injury a $500.00 civil penalty is being assessed.

“Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.”

Exit interview was conducted. 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 was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISOR'S NAME: Bertha Manzanares	TELEPHONE: (714) 703-2805
LICENSING EVALUATOR NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

LIC9099 (FAS) - (06/04)

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