304371150-12-6-2023-06-CC-PMAA-CYBM96-20231208082409

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371150
Report Date: 12/06/2023
Date Signed: 12/06/2023 09:35:09 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 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
08/07/2023 and conducted by Evaluator Araceli Bootorabi

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20230807143929

FACILITY NAME:	INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESA		FACILITY NUMBER:	304371150
ADMINISTRATOR:	MARIA TEEL		FACILITY TYPE:	830
ADDRESS:	2950 MCCLINTOCK WAY		TELEPHONE:	(714) 966-0303
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	22	CENSUS:	DATE:	12/06/2023
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	MARIA TEEL		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Infant sustained unexplained fracture while in care.

INVESTIGATION FINDINGS:

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LPA was greeted by Director MARIA TEEL on 12/06/2023 LPA Bootorabi informed the director the purpose of the visit. The purpose of today’s visit is to deliver findings for the above allegation.
The census upon entry on 12/6/2023 was as follows:

Orange Room - 9 Children – 2 Staff Nido Room - 4 Children – 2 Staff

The facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, before initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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-20230807143929

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESA	FACILITY NUMBER: 304371150
	VISIT DATE: 12/06/2023

NARRATIVE

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The allegation is that an infant sustained an unexplained fracture while in care.

The Department received a complaint on 08/07/2023 alleging that an infant sustained an unexplained fracture while in care.
The complaint was assigned to the Department’s Investigations Branch’s Investigator Angelica Medina. Medina interviewed complainant, parents, staff, medical personnel, and reviewed records.

Medina interviewed Parent (P1) on 10/25/2023. P1 stated the Child (C1) was dropped off by (P1) in the morning and picked up by Parent #2 (P2). After dinner on 04/01/2022 P2 was assisting C1 with hand washing when C1 began to cry. P1 states that the initial thought was that C1 had sprained their arm and it was not until bath time that C1 began to guard their arm and the arm began to look swollen. P1 and P2 believed that the arm may have been hurt at day-care. A message was sent to C1’s pediatrician on 04/02/2022 to schedule an office visit. P1 and P2 were able to secure an appointment with the pediatrician on 04/05/2022, P1 stated that the Pediatrician's diagnosis was that C1 had a greenstick fracture (A greenstick fracture is a type of broken bone. A bone cracks on one side only, not all the way through the bone).

On 08/14/2023 IB investigator interviewed staff present on the day of the alleged incident, Staff #1 – Staff #3 (S1, S2,S3) , and Staff #4 (S4) on 08/15/2023.

Staff #1 (S1) stated that the facility was notified about the alleged incident that occurred on Friday, 04/01/2022 until Monday, 04/04/2022 around 2:10 p.m via the facility’s day-care app. the facility uses to communicate with families. S1 stated whenever a child falls or hurts themselves, they inform the parents and take pictures right away through the day-care app.

S2 was interviewed on 08/14/2023 by Medina. S2 mentions that they did not witness C1 hurting themselves and recalled C1 using both arms to move around the classroom on 04/01/2022. S2 mentions not witnessing any bruising on C1's left arm that day.

S3 was interviewed on 08/14/2023 by Medina. S3 states not witnessing C1 having any falls or hurting themselves while in care. S3 mentions that if anything had occurred staff would report it. S3 mentions that C1 crawling and was adjusting to standing while holding on to things.

S4 was interviewed on 10/16/2023 by Medina. S4 states they did not witness anything concerning occur to C1 on 04/01/2022. S4 mentions staff using the app to communicate with families about the children's day.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20230807143929

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESA	FACILITY NUMBER: 304371150
	VISIT DATE: 12/06/2023

NARRATIVE

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Two Parent Interviews were conducted by Medica. Medina interviewed both P3 and P4, no disclosures were made.

Medina reviewed the following documents: Facility Roster, C1’s file, Unusual Incident Report for the alleged incident, , C1’s classroom daily report for 04/01/2022, and Medical Records.

Based on IB investigator Angelica Medina including staff and parent interviews; and record review there is not enough evidence to substantiate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Director, MARIA TEEL. Notice of Site Visit was posted during the visit. The director was informed that the notice of the site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The director was provided with 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 at the address listed above.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

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