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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374845327
Report Date: 04/27/2021
Date Signed: 04/27/2021 08:59:47 AM

Substantiated


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
03/18/2021 and conducted by Evaluator James Wilkerson
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20210318135414
FACILITY NAME:PEPPERTREE MONTESSORIFACILITY NUMBER:
374845327
ADMINISTRATOR:GARCIA, LYNNFACILITY TYPE:
830
ADDRESS:427 COLLEGE BLVD, STE ITELEPHONE:
(760) 940-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:40CENSUS: 24DATE:
04/27/2021
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Lynn GarciaTIME COMPLETED:
09:05 AM
ALLEGATION(S):
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Staff are not supervising children at all times.

Staff did not intervene in inappropriate actions between children in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) James Wilkerson arrived at this facility to conclude an investigation into the above allegations. An initial visit was conducted on 03/25/21 and extended at that time. LPA toured the facility and conducted census. There was an allegation that a child had been bitten and scratched by another child and that staff did not know how this occurred. There was another allegation that staff did not observe how a child scratched or bit another child. Interviews were conducted with staff, children and copies of facility documents (Incident-Accident-Injury Reports) were provided to LPA. During interviews it was disclosed that a child had been scratched and/or bitten and staff did not observe these incidents, and had to ask the child what had happened. Copies of facility Incident-Accident-Injury Report indicate that these occurrences happened from 01/14/21 to 03/18/21 and it involved different children. From the information received from the interviews that staff had to ask a child where he/she received a scratch/bite from and that an Incident-Accident-Injury Report shows a child had gotten bitten by an unknown child the allegations will be SUBSTANTIATED.

SEE NEXT PAGE
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Dawn Parker
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
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
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
03/18/2021 and conducted by Evaluator James Wilkerson
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20210318135414

FACILITY NAME:PEPPERTREE MONTESSORIFACILITY NUMBER:
374845327
ADMINISTRATOR:GARCIA, LYNNFACILITY TYPE:
830
ADDRESS:427 COLLEGE BLVD, STE ITELEPHONE:
(760) 940-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:40CENSUS: DATE:
04/27/2021
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Lynn GarciaTIME COMPLETED:
09:05 AM
ALLEGATION(S):
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Facility did not report unusual incident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) James Wilkerson arrived at this facility to conclude an investigation into the above allegation. LPA toured the facility and conducted census. An initial visit was conducted on 03/25/21 and extended at that time. An allegation was made that a child in care was bitten and/or on 01/17/21. LPA discussed this matte with Director, Lynn Garcia. During the course of this investigation, LPA conducted interviews with staff and obtained some facility documents (Incident-Accident-Injury Reports). Staff indicate that they do write up the reports, however, there are no Incident-Accident-Injury Report available for review for the date of 01/17/21. Ms. Garcia denies that the above allegation is true. Staff stated that If there were no incidents for 01/17/21, there would be no report. LPA cannot prove that an incident happened on this date and cannot prove that an incident didn't happen on this date. LPA received conflicting information on the allegation.

SEE NEXT PAGE

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Dawn Parker
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 10-CC-20210318135414
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: PEPPERTREE MONTESSORI
FACILITY NUMBER: 374845327
VISIT DATE: 04/27/2021
NARRATIVE
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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, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, a Notice of Site Visit posted, appeal rights discussed and provided along with a copy of this report on this date to Ms. Garcia. A copy of this report must be made available to public, upon request for three years.
SUPERVISORS NAME: Dawn Parker
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 10-CC-20210318135414
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: PEPPERTREE MONTESSORI
FACILITY NUMBER: 374845327
VISIT DATE: 04/27/2021
NARRATIVE
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There was an allegation that staff did not intervene in inappropriate actions between children in care. As the biting and scratching incidents happened and staff were unaware of the incidents until children told them what had happened. This allegation will be included with the allegation of lack of supervision as it falls under the same Title 22 Regulation.

See LIC 9099D for deficiency cited.

An exit interview was conducted, Notice of Site Visit posted, appeal rights discussed and provided along with a copy of this report to Ms. Garcia on this date.

A copy of this report must be made available, upon request for three years.
SUPERVISORS NAME: Dawn Parker
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 10-CC-20210318135414
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: PEPPERTREE MONTESSORI
FACILITY NUMBER: 374845327
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2021
Section Cited
CCR
101229(a)(1)
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101229 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). Supervision shall include visual observation.
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Director, Lynn Garcia agrees to hold a staff meeting and supply a copy of the agenda to Community Care Licensing complete with staff signatures by 05/04/21.
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shall include visual observation. This requirement was not met as evidence by staff not knowing how a child got scratched/bitten without asking the child what had happened and the inappropriate interactions, biting & scratching between children.This is a potential risk to the health and safety of children in care
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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.
SUPERVISORS NAME: Dawn Parker
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5