304371040-6-26-2019-06-CC-JHAN-BE6QJZ-20190717121333

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371040
Report Date: 06/26/2019
Date Signed: 06/26/2019 02:27:58 PM

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
05/29/2019 and conducted by Evaluator Cindy Nguyen

COMPLAINT CONTROL NUMBER: 06-CC-20190529142046

FACILITY NAME:	BELLA MONTESSORI		FACILITY NUMBER:	304371040
ADMINISTRATOR:	BARCELONA, ROSIE		FACILITY TYPE:	830
ADDRESS:	20602 PRISM PLACE		TELEPHONE:	(949) 900-2420
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	40	CENSUS: 25	DATE:	06/26/2019
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Director, Evangelista, Stefanie		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff operating out of ratio.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nguyen conducted an unannounced complaint inspection to investigate the above allegation. This is a continuation of the investigation initiated on 06/03/2019. LPA met with Director, Stefanie Evangelista. Census was taken. There were a total of 25 infants with 8 staff observed. During the head count of the infant classrooms, LPA observed in the infant classroom (age 0-12 months) had 12 infants with 5 staff. In the toddler 1 classroom, LPA observed 13 napping infants (age 12-24 months) with 3 staff. During today's inspection staffing and capacity ratios were being met. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the course of the investigation, LPA conducted 2 physical plant inspections, interviewed 10 staff members, reviewed/obtained classroom schedules, children's sign in/out, staff time cards and obtained a copy of the children's roster.
Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

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-20190529142046

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: BELLA MONTESSORI	FACILITY NUMBER: 304371040
	VISIT DATE: 06/26/2019

NARRATIVE

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All staff denied of operating out of ratio, a review of two weeks staff time cards, children’s sign-in/out sheets, and daily schedules do not support the allegation. Based on the records reviewed, there appeared to be enough staff present to maintain ratio with the number of children signed in.

Based on LPA observations and interviews which were conducted and record reviews, the preponderance of evidence was not met, therefore the above allegation is found to be UNSUBSTANTIATED. Although the allegation 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.

Exit interview was conducted with Director, Stefanie Evangelista. Notice of Site Visit was posted during the visit. Facility representative 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.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

LIC9099 (FAS) - (06/04)

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