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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313621507
Report Date: 12/28/2020
Date Signed: 12/28/2020 09:03:12 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2020 and conducted by Evaluator Katrina Owens
COMPLAINT CONTROL NUMBER: 03-CC-20201120084341
FACILITY NAME:ROSEVILLE MONTESSORI ACADEMY (PS)FACILITY NUMBER:
313621507
ADMINISTRATOR:RICHARDSON, KARENFACILITY TYPE:
850
ADDRESS:1370 BASELINE ROADTELEPHONE:
(916) 780-0230
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:96CENSUS: 19DATE:
12/28/2020
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karen Richardson - DirectorTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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OTHER: Facility is operating under an invalid business entity.
INVESTIGATION FINDINGS:
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An unannounced telephone call was conducted today by Licensing Program Analyst Owens due to COVID-19. LPA Owens spoke with Director, Karen Richardson. The purpose of the telephone call was to close a complaint investigation that was originally opened on December 1, 2020.

Based on interviews and information received from the California Secretary of State and Franchise Tax Board the facility is not in compliance with these agencies regulations; therefore, making the facility out of compliance with Licensing Regulations. The preponderance of evidence standard has been met during this investigation, therefore the above allegation is found to be SUBSTANTIATED.

Violations of the California Code of Regulations, Title 22, Division 12 & Chapter 3 are being cited on the attached LIC 9099 D.

Exit interview conducted and Notice of cite visit to be posted.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2020
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 03-CC-20201120084341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ROSEVILLE MONTESSORI ACADEMY (PS)
FACILITY NUMBER: 313621507
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/23/2021
Section Cited
CCR
101151(b)
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GENERAL:
The licensee shall ensure compliance with all applicable laws and regulations.
This requirement is not met as evidence by:
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LPA Owens spoke with owner of facility and he stated he has contacted the appropriate agencies and will send CCLD copies of the documents showing he is in compliance. He will submit
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The Owner is not in compliance with the California Secretary of State and the Franchise Tax Board laws and regulations. Therefore, the owner is not in compliance with the Licensing Regulations. This is a potential risk to children.
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documents to CCLD on or before 2/23/21.
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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.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2