364843031-6-7-2021-09-CC-GSEA-C54LYS-20210720091046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 364843031
Report Date: 06/07/2021
Date Signed: 06/07/2021 08:17:34 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
05/24/2021 and conducted by Evaluator Diana Brasel

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20210524142741

FACILITY NAME:	ST. MARY'S MONTESSORI SCHOOL - FONTANA		FACILITY NUMBER:	364843031
ADMINISTRATOR:	CYNTHIA DAVILA		FACILITY TYPE:	850
ADDRESS:	7370 W. LIBERTY PARKWAY		TELEPHONE:	(909) 200-4747
CITY:	FONTANA	STATE: CA	ZIP CODE:	92336
CAPACITY:	129	CENSUS: 25	DATE:	06/07/2021
		UNANNOUNCED	TIME BEGAN:	04:40 PM
MET WITH:	Acting Director Deseree Jones, Director of Rancho Emily Turner, Nel Jayawardana Owner		TIME COMPLETED:	07:30 PM

ALLEGATION(S):

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1. Staff did not properly supervise daycare child.
2. Licensee did not report incident to appropriate parties.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Diana Brasel arrived at the facility to deliver the concluded findings into the above allegations. An initial tele-inspection visit was conducted on 05/28/2021 via facetime. LPA arrived at the facility on the above noted date and time, a tour and a census was conducted. The following information has been obtained through interviews and statements.
1. Staff did not properly supervise daycare child: On 05/18/2021 the classroom was outside playing, there were 16 children with two staff members. Upon the clean-up transition to go to the gated outdoor environment, a child was left on the play structure without direct supervision from 10:54 am - 11:12 am., although the staff were outside during the time frame they were not located near the structure that the child was actively playing on. One staff member took the first group of 8 children inside, then the second staff member took the additional group of children inside leaving the child on the playground from 11:12 am - 11:17 am with no adult supervision at all. The staff admitted to not doing a head count or a name to face.
At 11:17 a third staff member entered the classroom noticing that the child was not insight, the staff member asked the other two staff members where the child was, ----CONTINUED ON LIC 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana Brasel	TELEPHONE: 951-782-4952
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

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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Control Number 09-CC-20210524142741

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: ST. MARY'S MONTESSORI SCHOOL - FONTANA	FACILITY NUMBER: 364843031
	VISIT DATE: 06/07/2021

NARRATIVE

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at which time the third staff member noticed the child was left outside. The staff member immediately went outside and brought the child into the classroom. The child had no injuries.
2. Licensee did not report incident to appropriate parties: It was learned that the staff team members in the room where the incident occurred did not report the incident to the Director or upper management. The incident was learned from another source and then brought to the Directors attention late evening of the day of the incident. The Director did not report the incident to Licensing or the authorized parties.

Based upon the information gathered, the preponderance of evidence standard has been met these allegations are therefore substantiated.
See LIC 9099D for deficiencies cited per California Code Regulations Title 22, Division 12.

An exit interview was conducted.

A Notice of site visit was issued and must be posted for 30 days.

A copy of appeal rights LIC9058 and the signature of this report acknowledges receipt of the appeal rights.

A copy of this report must be available to the public for three years.

LPA provided a copy of a completed LIC 9224 to be provided to parents of children enrolled.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana Brasel	TELEPHONE: 951-782-4952
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

LIC9099 (FAS) - (06/04)

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Control Number 09-CC-20210524142741

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: ST. MARY'S MONTESSORI SCHOOL - FONTANA	FACILITY NUMBER: 364843031
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/08/2021 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2 (e)(1) and 101230(c)(1). Super-	1 2 3 4 5 6 7	Management held an all staff training on 06/01/202, which included Name to Face. Documentation was provided to LPA showing the Name to Face log was reveiwed with all staff on 05/20/2021. Per management further training will be conducted and proof will be provided.
	8 9 10 11 12 13 14	vision shall include visual observation. This requirement was not met as evidence by: Staff admitted to leaving a child without direct supervison for 18 min. and without no adult supervison for 5 min. This poses an potential health and safety risk to the children in care. Civil penalties assessed.	8 9 10 11 12 13 14	POC corrected at time of visit.
	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: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana Brasel	TELEPHONE: 951-782-4952
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 09-CC-20210524142741

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: ST. MARY'S MONTESSORI SCHOOL - FONTANA	FACILITY NUMBER: 364843031
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/14/2021 Section Cited CCR 1012129(d)(1)(c)	1 2 3 4 5 6 7	Reporting Requirements: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following:	1 2 3 4 5 6 7	A completed Unusual Incident Report was submitted to licensing on 06/03/2021, which was after the initial complaint visit. Cleared at time of visit.
	8 9 10 11 12 13 14	(C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by: The director had knowledge of a child not supervised/left unattended and failed to report the incident to the Department.	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: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana Brasel	TELEPHONE: 951-782-4952
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

LIC9099 (FAS) - (06/04)

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