304371040-3-20-2024-06-CC-PMAA-D3XP5V-20240402110120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371040
Report Date: 03/20/2024
Date Signed: 03/20/2024 11:52:25 AM

Unsubstantiated

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
01/18/2024 and conducted by Evaluator Cindy Nguyen

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20240118094242

FACILITY NAME:	BELLA MONTESSORI		FACILITY NUMBER:	304371040
ADMINISTRATOR:	EVANGELISTA, STEFANIEAN		FACILITY TYPE:	830
ADDRESS:	20602 PRISM PLACE		TELEPHONE:	(949) 900-2420
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	40	CENSUS: 20	DATE:	03/20/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Director, Stefanie Evangelista		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Day care child(ren) sustained unexplained injuries while in care.
Staff did not provide adequate supervision to day care child(ren).
Staff did not follow reporting requirements.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced complaint investigation. This is a continuation of the investigation initiated on 01/24/2024. Upon arrival LPA met with the Director, Stefanie Evangelista who accompanied LPA on a tour of the facility. Census was taken. The overall census observed was 20 infants with 7 staff members. 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 01/18/2024 a complaint was filed with the Department alleging that day care child(ren) sustained unexplained injuries while in care, staff did not provide adequate supervision to day care child(ren), and staff did not follow reporting requirements. During the investigation, LPA Nguyen conducted 2 physical plant inspections, interviewed 4 staff members, obtained/review facility children's roster, classroom's roster, parents handbook, and incident reports. Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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 06-CC-20240118094242

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: 03/20/2024

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 9099C

Complainant alleged that a child received multiple physical injuries and facility didn’t report or notify of the injuries . LPA interviewed the complainant, who stated that the facility had contacted the complainant and explained what had happened along with having an incident/accident report all filled out, but the closing staff forgot to give it during pick up.

During the staff interview, all the staff interviewed stated that the facility is always within compliance with children's personal rights and supervision regulations. Staff #2 (S2) and Staff #3 (S3) stated they both observed a child was walking, fell, and bit child’s lips. An accident/incident report was filled out by S2, but S3 stated S3 forgot to give the report to the parent during pick up. S2 contacted the parent the next day and explained what had happened to the child and why an accident/incident wasn’t given to the parent yesterday. S3 gave the accident/incident report to the parent the next day . S2 stated the facility protocol for any head injuries or major injuries are to care for the wound, write an incident report, and contact the parents immediately. If it is the minor injuries, the staff observed the child, write the incident report, and talked to parents at the end of the day.

LPA called 8 parents and left message for return calls. The parents interviewed did not express any concerns.

Based on LPA observations, document reviews and interviews which were conducted, the preponderance of evidence was not met, therefore the above allegations are found to be UNSUBSTANTIATED. 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 allegations are UNSUBSTANTIATED.

Exit interview was conducted with Director, Stefaniean Evangelista. 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. 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: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2