343622305-10-12-2021-03-CC-KPES-C7YUQZ-20211020154755

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343622305
Report Date: 10/12/2021
Date Signed: 10/12/2021 01:01:36 PM

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
07/15/2021 and conducted by Evaluator Katrina Owens

COMPLAINT CONTROL NUMBER: 03-CC-20210715081048

FACILITY NAME:	COUNTRY HILL MONTESSORI, INC.		FACILITY NUMBER:	343622305
ADMINISTRATOR:	BYRD, TANYA		FACILITY TYPE:	850
ADDRESS:	6131 KENNETH AVENUE		TELEPHONE:	(916) 969-2929
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	60	CENSUS: 67	DATE:	10/12/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Tanya Byrd - Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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LACK OF SUPERVISION: Child sustained a fractured sternum while in care.

INVESTIGATION FINDINGS:

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An unannounced inspection was conducted today by Licensing Program Analyst Owens and Blesi. LPA's met with Tanya Byrd, Director. The purpose of the inspection is to close a complaint investigation that was originally open by Investigator, Joseph Ballarie from Investigations Branch (IB) on July 22, 2021.

Based upon the interviews conducted, there was not a preponderance of evidence to support the above allegation or incident occurred therefore, this complainant is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur.

An exit interview was conducted. Appeal rights were given and explained to the Director.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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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