334841371-7-2-2019-09-CC-DPAR-BF9KWG-20190821081553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334841371
Report Date: 07/02/2019
Date Signed: 07/02/2019 01:15:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/25/2019 and conducted by Evaluator Sean R Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20190425141008

FACILITY NAME:	TEMECULA MONTESSORI ACADEMY		FACILITY NUMBER:	334841371
ADMINISTRATOR:	SONES, MELINDA		FACILITY TYPE:	830
ADDRESS:	27635 JEFFERSON AVENUE		TELEPHONE:	(951) 676-6464
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92590
CAPACITY:	30	CENSUS: 7	DATE:	07/02/2019
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Melinda Sones		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Day care child was given another child’s food

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA's) Sean Williams arrived at the facility to follow up on a complaint investigation. LPA met with Director Melinda Sones. A census was taken; the facility was toured. It was alleged that a day care child was given another child’s food. It was reported that a facility staff member gave the wrong yougurt from one infants container to another infant who was lactose intolerant. It was reported that the yogurt that was given to the second infant cause them to have an upset stomach for the rest of the night.

During the course of the investigation, LPA Sean Williams conducted interviews with staff, and all other relevant individuals pertinent to this investigation. It was learned during staff interviews, that a staff member who is no longer employed at the facility accidentally gave the wrong yougurt to an infant although the infants container was clearly marked to identify who the container belonged to. Based on the information gathered, the preponderance of evidence standard has been met, and the above allegation is found to be SUBSTANTIATED. (SEE9099D)

Exit interview conducted and a copy of this report was provided to Director Melida Sones on this date.

Substantiated

Estimated Days of Completion: 60

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-0203
LICENSING EVALUATOR NAME: Sean R Williams	TELEPHONE: (951) 782-4951
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019

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 09-CC-20190425141008

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: TEMECULA MONTESSORI ACADEMY	FACILITY NUMBER: 334841371
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/02/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/09/2019 Section Cited CCR 101427(c)	1 2 3 4 5 6 7	Infant Care Food Service. The infant shall be fed in accordance with the individual plan. It was reported that a facility staff member accidentally fed an infant the wrong yogurt even though the container was labeled properly with the child's name on it. Staff also reported that the infant's parent complained that the infant had an upset stomach all that night.	1 2 3 4 5 6 7	Facility Director agrees to train infant staff to follow the infant individual food plan, and provide proof of the training to CCL by 7/9/2019.
	8 9 10 11 12 13 14	This requirement was not met due to staff not following the infants indiviual plan by giving the wrong yogurt to the infant.	8 9 10 11 12 13 14
	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.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-0203
LICENSING EVALUATOR NAME: Sean R Williams	TELEPHONE: (951) 782-4951
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2019

LIC9099 (FAS) - (06/04)

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