304371475-4-20-2023-06-CC-JHAN-CRJN2W-20230505100522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371475
Report Date: 04/20/2023
Date Signed: 04/20/2023 02:11:15 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
04/13/2023 and conducted by Evaluator Carmen Odom

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20230413152420

FACILITY NAME:	BUENA PARK MONTESSORI ACADEMY		FACILITY NUMBER:	304371475
ADMINISTRATOR:	SAVITHRI DE ALWIS		FACILITY TYPE:	830
ADDRESS:	6221 LINCOLN AVENUE		TELEPHONE:	(714) 821-7800
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	27	CENSUS: 15	DATE:	04/20/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Vivian Neino - Director		TIME COMPLETED:	12:29 PM

ALLEGATION(S):

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Staff did not follow reporting requirements.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Odom and Gutierrez conducted an unannounced complaint investigation. Upon arrival LPAs met with Director, Vivian Neino who guided LPAs on a tour of the facility. At 9:35am LPAs observed a total of 15 infants and toddlers getting ready to eat morning snack with 3 staff members.

A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The department received a complaint on 04/13/23 alleging staff did not follow reporting requirements. Complainant Party (CP) reported that the director of the facility was providing misleading information of the recent violations that occurred in the facility regarding children’s personal rights and not being completely transparent in providing a copy of the report dated 3/29/23.
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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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-20230413152420

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: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 04/20/2023

NARRATIVE

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During the investigation LPA Odom interviewed complainant party, director, 1 staff member, conducted a facility inspection, and reviewed children’s roster. LPA Gutierrez attempted to interview 19 parents however only 14 parents were available for interview on 4/10/23 to 4/12/23.

On 04/06/2023 LPA Gutierrez made an unannounced visit to the facility for the purpose of a case management inspection. During the visit LPA reviewed 20 children’s files for the children present that day in the infant and toddler component. It was revealed that 11 out of the 20 children did not have a signed Acknowledgement of Receipt of Licensing Report (LIC 9224) forms for the date of 03/29/2023.

On 04/10/2023 -04/12/2023 LPA Gutierrez contacted 19 parents via phone calls to meet the departments’ objective to ensure that copies of the Acknowledgement of Receipt of Licensing Report (LIC 9224) forms with the dates of 03/29/2023 and 04/06/2023 were provided and signed by the parents contacted. 14 parents stated that they recall signing the forms and LPA left voicemail for the other 5 parents with no returned phone call. 3 out of the 19 parents stated they only received either 3 or 4 pages from the 10-page report dated on 03/29/2023 and did not receive the report dated on 04/06/2023. 6 parents stated they were only verbally informed about the incidents by the director. 6 of the parents stated they did not receive a copy of the acknowledgement form, the director only told the parents there was a complaint regarding a parent alleging a child was medicated, and the video footage viewed by licensing revealed additional violations. The director told parents that the violation was about having blankets and bottles inside the cribs with the babies, and teachers were fired. 4 parents stated that they received copies but did not disclose what copies were received. On 4/10/23 and 4/11/23 4 parents provided copies of the report that was given to them by the director to LPA. Upon reviewing the reports that were provided by parents LPA observed that partial copies were provided to the parents and the reports were altered by removing the page numbers on the reports for the date of 03/29/2023.

During the investigation, Director (S1) was interviewed on 4/20/23. S1 stated they did not provide the 3/29/23 licensing report to all infant families by the next business day. S1 stated they did provide a copy of the 4/6/23 licensing report to each family by the next business day. S1 stated they sent proof of the signed acknowledgement receipts LIC9224 to LPM Gutierrez on 4/7/23. S1 stated they provided a full copy of the 3/29/23 and 4/6/23 licensing reports to each family and they did not alter the report.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20230413152420

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: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 04/20/2023

NARRATIVE

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During the investigation, 1 staff member was interviewed on 4/20/23. Staff #2 (S2) stated they do not know if S1 provided a full copy of the licensing report each infant family, but they did observe S1 speaking with each family member in their office.

Based on LPA’s facility inspection, observations, interviews conducted with complainant party, director, 1 staff, 14 parents, and records reviewed, it has been determined that Staff did not provide a copy of the report dated 3/29/23 by the next business day and the licensing report was altered by removing the page numbers that was provided to parents. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, 101163(a) False Claims is being cited on the attached LIC 9099D.

Licensee will make sure this report dated 4/20/2023 document 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.
Also, Licensee is to provide a copy of this licensing report dated 4/20/2023 that documents any Type A citation 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 not conducted with Director Vivian Neino who refused to sign the report. Notice of Site Visit was posted during the visit. Licensee 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.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20230413152420

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: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/20/2023 Section Cited CCR 101163(a)	1 2 3 4 5 6 7	101163 False Claims (a) No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the child care center or any of the services provided by the center. This requirement was not met: Based on interviews conducted with 14 parents Director provided misleading	1 2 3 4 5 6 7	Licensee shall send an e-mail to all authorized representative for the infant and toddlers moving forward to be more transparent and to be availble to express any concerns they might have. Director will send a copy of the communicate letter to parent and how the copy was delivered by the due date of 4/21/23 by 3:00pm.
	8 9 10 11 12 13 14	information by not revealing all the violations that were cited on 3/29/23. Director did not provide the 10-page report dated 3/29/23 to each infant family. On 4/6/23 11 out 20 parents did not have signed acknowledgement receipts in the children’s files. This poses an immediate risk to the safety and health of the children in care.	8 9 10 11 12 13 14	via e-mail carmen.odom@dss.ca.gov
	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.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

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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
04/13/2023 and conducted by Evaluator Carmen Odom

COMPLAINT CONTROL NUMBER: 06-CC-20230413152420

FACILITY NAME:	BUENA PARK MONTESSORI ACADEMY		FACILITY NUMBER:	304371475
ADMINISTRATOR:	SAVITHRI DE ALWIS		FACILITY TYPE:	830
ADDRESS:	6221 LINCOLN AVENUE		TELEPHONE:	(714) 821-7800
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	27	CENSUS: 15	DATE:	04/20/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Vivian Neino - Director		TIME COMPLETED:	12:29 PM

ALLEGATION(S):

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Day care child sustained unexplained injuries due to lack of staff supervision while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Odom and Gutierrez conducted an unannounced complaint investigation. Upon arrival LPAs met with Director, Vivian Neino who guided LPAs on a tour of the facility. At 9:35am LPAs observed a total of 15 infants and toddlers getting ready to eat morning snack with 3 staff members.

A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The department received a complaint on 04/13/23 alleging childcare child sustained unexplained injury while in care. Complainant Party (CP) reported on 3/22/23 during pick up time CP observed child #1 (C1) had visible circular mark on the right ankle that looked like a possible rash or red marks. CP provided pictures.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 06-CC-20230413152420

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: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 04/20/2023

NARRATIVE

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During the investigation LPA Odom interviewed complainant party, director, 1 staff member, conducted a facility inspection, and reviewed children’s roster, daily report, staff time sheet and attendance sheet for 3/22/23. LPA Gutierrez interviewed 14 parents on 4/10/23 to 4/12/23.

During the investigation, Director (S1) was interviewed on 4/20/23. S1 stated on 3/22/23 was their first day as a director in the facility and they do not recall a child being injured on that day. S1 disclosed they have been actively working in making sure the staff are staying in ratio in the infant and toddler classroom.

During the investigation, 1 staff member was interviewed on 4/20/23. Staff #2 (S2) stated they did not see any marks on C1’s body on 3/22/23. S2 stated they conduct a wellness check on infants of their visible body parts like face and arms, but they do not check under their clothing. S2 stated if a child gets hurt while in care they will apply aide, write an incident report, notify the director and provide a copy of the incident report to the authorized representative.

LPA Gutierrez attempted to interview 19 parents however only 14 parents were available for interview on 4/10/23 to 4/11/23. None of the parents disclosed any concerns with physical injuries on the childcare children.

LPAs reviewed provided documents and it was determined that the infant classroom was in compliance to staff and ratio. C1’s daily report did not indicate any marks or injuries on 3/22/23.

Based on LPA’s facility inspection, observations, interviews conducted with complainant party, director, 1 staff, 14 parents and records reviewed it was determined there was insufficient evidence that C1 sustained injury while in care. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

Exit interview was not conducted with Director Vivian Neino, director refused to sign report. Notice of Site Visit was posted during the visit. Licensee 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. Licensee 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.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

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