<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364830892
Report Date: 08/25/2021
Date Signed: 08/25/2021 03:13:18 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 ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/28/2021 and conducted by Evaluator Rachel Zeron
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20210728162251
FACILITY NAME:MONTESSORI ACADEMY OF CHINOFACILITY NUMBER:
364830892
ADMINISTRATOR:DE SILVA, MAVANANEFACILITY TYPE:
850
ADDRESS:4511 RIVERSIDE DRIVETELEPHONE:
(909) 591-3937
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:60CENSUS: 23DATE:
08/25/2021
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Thushara Desilva Director and Asssistant Director Ariana GOmezTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Facility is operating out of ratio
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rachel Zeron arrived at the facility to conduct a visit regarding a complaint received concerning the above allegations. LPA Zeron toured the/ facility and took a census. LPA Zeron met with Directors to further discuss the complaint/allegations. On 08/19/2021, a visit was previously conducted regarding the complaint, on that visit, staff were interviewed and files were reviewed.

The following was alleged: Facility is not operating within teacher: child ratio.
LPA Zeron investigated the above allegation and gathered the following information regarding the issue concerning ratio, it was disclosed that one teacher is at the center from 7:00 am to 8:00 am alone supervising up to 15 children. LPA reviewed records for a two week period and found that on 07/27/2021 one teacher, 14 children; 07/28/2021, one teacher 14 children; 07/29/2021 one teacher 15 children. Further investigation found that some of the children belonged to the private Kindergarten on site, this issue is addressed on a separate case management..Interviews revealed that the Director admitted due to staff shortage, the center was occasionaly out of ratio from the hours 7:00 am to 8:00 am.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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 5
Control Number 09-CC-20210728162251
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MONTESSORI ACADEMY OF CHINO
FACILITY NUMBER: 364830892
VISIT DATE: 08/25/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on LPAs observations and interviews which were conducted and a review of additional pertinent information obtained, the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated. California Code of Regulations, Title 22, Division 12, Chapter 1, is being cited on the attached LIC 9099D.

The Director was provided a copy of their appeal rights (LIC9058) and their signature on this form acknowledges receipt of these rights.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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 ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/28/2021 and conducted by Evaluator Rachel Zeron
COMPLAINT CONTROL NUMBER: 09-CC-20210728162251

FACILITY NAME:MONTESSORI ACADEMY OF CHINOFACILITY NUMBER:
364830892
ADMINISTRATOR:DE SILVA, MAVANANEFACILITY TYPE:
850
ADDRESS:4511 RIVERSIDE DRIVETELEPHONE:
(909) 591-3937
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:60CENSUS: DATE:
08/25/2021
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9

-Staff failed to provide a comfortable environment for children in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
During the investigation, LPA Zeron made observations, conducted interviews with Director and all other relevant individuals pertinent to this investigation. It was reported that Staff failed to provide a comfortable environment for children in care. It was indicated that staff is unfriendly towards children in care.

During interviews with staff and children, there was no indication of staff conducting unfriendly behavior towards children. Children's interviews revealed that all staff is nice. Staff interviews indicated that they have not been unfriendly towards children, nor have they witnessed other staff display unfriendly demeanor towards children.

Due to conflicting statements, LPA cannot determine if the above allegation is true. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated at this time.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 09-CC-20210728162251
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MONTESSORI ACADEMY OF CHINO
FACILITY NUMBER: 364830892
VISIT DATE: 08/25/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Upon receipt of this report, licensee is required to provide a copy of the LIC9099D documenting Type A deficiencies to children's parents and obtain signatures from the parents on Form LIC9224. For the next 12 months, licensee is required to provide a copy of the LIC9099D to all newly enrolled families. A copy of this report must be made available to the public upon request for the next 3 years.

An exit interview was conducted. A copy of this report was provided .A Notice of site visit was given to the Director and LPA observed the notice posted. Director agreed to keep the notice posted for the next 30 days.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 09-CC-20210728162251
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MONTESSORI ACADEMY OF CHINO
FACILITY NUMBER: 364830892
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2021
Section Cited
CCR
101216.3
1
2
3
4
5
6
7
 Teacher-Child Ratio - There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance. This requirement was not met as evidenced by: Complaint investigation revealed that in the mornings from 7:00am - 8:00 am there is one teacher present and up to 15 children at one time. This conduct poses a potential risk to the health and safety of children in care.
1
2
3
4
5
6
7
Assistant Director agreed to come in to the facility at 7:00 am starting 08/19/2021 to assist the teacher on duty to stay in compliance.

Schedule was updated. POC cleared
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
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: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5