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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371465
Report Date: 08/07/2023
Date Signed: 08/07/2023 04:30:32 PM

Substantiated


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
05/17/2023 and conducted by Evaluator Dianna ValdezSantana
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230517093428
FACILITY NAME:SMILES MONTESSORI CHILDCAREFACILITY NUMBER:
304371465
ADMINISTRATOR:AHN, SUNG JAFACILITY TYPE:
830
ADDRESS:2261 NORTH ORANGE OLIVE ROADTELEPHONE:
(714) 283-2857
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:20CENSUS: 7DATE:
08/07/2023
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Director, Sung Ja AhnTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff did not follow day care child's dietary restrictions.
Facility staff did not adequately supervise day care children.
INVESTIGATION FINDINGS:
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On 08/07/2023 Licensing Program Analyst (LPA) Dianna Valdez Santana made an unannounced visit to Smiles Montessori Childcare for the purpose to deliver findings of a complaint received. Upon arrival, LPA was met by Director, Sung Ja Ahn. Director was explained the reason for today’s visit. LPA was provided a tour of the facility and observed 2 Staff and 7 infant children present.
A review of the Facility Personnel Report Summary conducted on today’s date indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
On 05/17/2023 a complaint was filed with the Licensing office stating Facility staff did not follow day care child's dietary restrictions and Facility staff did not adequately supervise day care children.
Reporting Party (RP) stated, there have been multiple incidents where the facility gave the child dairy even after the paperwork and communication regarding the child has a severe allergy to dairy completed. On multiple occasions the Director informed parents they gave the child cheese, crackers, and pizza. On two occasions RP saw the child was drinking from another child's milk bottle. Page 1 of 3
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
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 4
Control Number 06-CC-20230517093428
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: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371465
VISIT DATE: 08/07/2023
NARRATIVE
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During the course of investigation, LPA interviewed 4 staff members, and 3 parents. No child interview were conducted due to being non-verbal.

During the staff interviews, LPA inquired about the procedure for allergies. Staff 1 (S1) demonstrated in one of the preschool rooms there was a list in the classroom that stated children with allergies. LPA asked if there was a list in the infant room. S1 stated none of the infants had any allergies. When LPA asked S1 about the infant allergy S1 stated S1 was unaware. Staff 2 stated one of the older infants has an allergy and they don’t give that child what they are allergic to. S3 stated one infant has an allergy, S3 stated they separate that child to ensure they don’t eat what they are allergic to. S4 stated the same child has an allergy and staff make sure the child doesn’t eat what they can’t have. 4 out of 4 staff failed to identify the second child that has an allergy. S2, S3 and S4 disclosed that children have drunk another child’s bottle and/or eaten another child’s food.

On 5/22/23 LPA Valdez Santana observed at least 2 bottles out of about 6-8 bottles sitting out that without a name label. LPA reminded Director/owner that all bottles need to be labeled with the child's name to ensure they are not giving the wrong bottle to any child. LPA did not observe an "Allergy list: posted in the infant classroom. Director showed LPA the "allergy list" posted in one of the preschool classrooms. When LPA asked Director why there was not one in the infant room, Director stated there was no one with allergies. LPA had reviewed 10 children's files and at least one child had an allergy, and it was not posted. Director said she was not aware that they had that allergy.



LPA observed at least 3 occasions where an infant took another infants food and ate it, S1 and S3 had no idea the incidents occurred because they were doing other things.

3 of 5 parents were interviewed, parents had no issues or concerns with the daycare.



Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1 Section 101227(7)(B) Food Services and 101229(a) Responsibility for Providing Care and Supervision is being cited on the attached LIC 9099D. Please refer to attached 9099D for documentation of deficiencies.
Page 2 of 3.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 06-CC-20230517093428
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: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371465
VISIT DATE: 08/07/2023
NARRATIVE
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LPA Valdez Santana informed Director, Sung Ja Ahn also known as Annie, that this report dated 8/07/23 documents two Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Valdez Santana informed the Director to provide a copy of this licensing report dated 8/7/23 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted. The Notice of Site Visit was posted. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

Page 3 of 3.End of Report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 06-CC-20230517093428
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: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371465
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2023
Section Cited
CCR
101227(7)(B)
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101227(7)(B) Food Services: (B) A child shall not be served any food to which the child's record indicates he/she has an allergy.

This requirement is not met as evidence by:
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Director stated she will email LPA Valdez Santana her plan to maintain compliance by POC due date and send it via email at dianna.valdezsantana@dss.ca.gov
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 Based on LPA’s interviews, 4 out of 4 staff members could not identify all the children that have allergies.LPA also observed bottles without children’s name and date on them. This poses a potential risk to the safety of the children in care.
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Type A
08/08/2023
Section Cited
CCR
101229(a)
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101229(a) Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision as necessary to meet the children's needs.

This requirement is not met as evidence by:
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Director stated she will email LPA Valdez Santana her plan to maintain compliance by POC due date and send it via email at dianna.valdezsantana@dss.ca.gov
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 Based on LPA’s interviews, 2 out of 2 staff members did not properly supervise children during mealtimes. Children were taking each other’s food and eating it and trying to take each other’s bottles. This poses an immediate risk to the safety of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4