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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374845327
Report Date: 11/09/2022
Date Signed: 11/09/2022 05:20:16 PM

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
10/07/2022 and conducted by Evaluator Andrea Taylor
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20221007162844
FACILITY NAME:PEPPERTREE MONTESSORIFACILITY NUMBER:
374845327
ADMINISTRATOR:HOWARD, KAYLAFACILITY TYPE:
830
ADDRESS:427 COLLEGE BLVD, STE ITELEPHONE:
(760) 940-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:40CENSUS: 30DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Cheryl Gillians-DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Personal Rights-Child's legs were tied together with a blanket by staff.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Taylor conducted a complaint inspection on today's date due to a complaint received in the licensing office on 10/7/22. LPA Taylor toured the facility, inside and out. Census was taken. There were 22 infants and 5 staff present during this inspection. A review of staff criminal clearance records on 11/9/22 indicates that all facility staff or other individuals who require caregiver background checks have received.

On October 7, 2022 this agency received an allegation that a childcare staff tied a blanket around a child’s legs at nap time. Confidential interviews disclosed two staff members observed the staff member tying the child’s legs. The two staff walked over to where the other staff member and child were in the nap area, insisting the child be untied. The staff untied the child. Other confidential interviews and record reviews confirmed the incident occurred.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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 6
Control Number 10-CC-20221007162844
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: 11/09/2022
NARRATIVE
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Page 2

LPA conducted interviews with staff members, and LPA obtained pertinent documents/information regarding the investigation during prior inspection conducted on 10/12/22.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, 101223-Personal Rights (a)(3) is being cited on the attached LIC 9099D.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.

If the facility receives a Type A violation, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days, and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.

An exit interview was completed. The report was reviewed and deficiencies discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
10/07/2022 and conducted by Evaluator Andrea Taylor
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20221007162844

FACILITY NAME:PEPPERTREE MONTESSORIFACILITY NUMBER:
374845327
ADMINISTRATOR:HOWARD, KAYLAFACILITY TYPE:
830
ADDRESS:427 COLLEGE BLVD, STE ITELEPHONE:
(760) 940-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:40CENSUS: 30DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Cheryl Gillians-DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff was on the phone leaving children unsupervised
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Taylor conducted a complaint inspection on today's date due to a complaint received in the licensing office on 10/7/22. LPA Taylor toured the facility, inside and out. Census was taken. There were 22 infants and 5 staff present during this inspection. A review of staff criminal clearance records on 11/9/22 indicates that all facility staff or other individuals who require caregiver background checks have received.

On October 7, 2022 this agency received an allegation that a childcare staff was on the phone while they should have been supervising children. The staff member on the phone could not provide the supervision as stated in the regulations.

LPA conducted interviews with staff members, and LPA obtained pertinent documents/information regarding the investigation during prior inspection conducted on 10/12/22.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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 6
Control Number 10-CC-20221007162844
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: 11/09/2022
NARRATIVE
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Page 2

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, 101229 Responsibility for Providing Care and Supervision is being cited on the attached LIC 9099D.

In the areas that were evaluated, the facility was not in compliance and violation, in accordance with California Code of Regulations, Health & Safety 1596.7995(a)(1), is being cited on the attached LIC 9099D.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 10-CC-20221007162844
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: 11/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/09/2022
Section Cited
CCR
101229(a)(1)
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 Responsibility for Providing Care and Supervision The licensee shall provide care and supervision as necessary to meet the children's needs. 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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The Director has retrained the staff they are not allowed to use their phones while at work.
The staff member who was on the phone no longer works at the facility.
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This was not met as evidenced by a staff member talking on the phone when supervising children.
The staff member no longer works at this facility. This is a potential risk to the health and safety of children.
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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.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 10-CC-20221007162844
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: 11/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2022
Section Cited
CCR
101223(a)(3)
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Personal Rights - To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: ...
This was not evidenced by a staff member tied a child's legs together.
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The staff who witnessed incident made the staff person untie the child's legs.
All of the staff will receive personal rights training and the Director will submit the agenda to LPA Taylor.

andrea.taylor@dss.ca.gov
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This is an immediate risk to the heath and safety of children.
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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.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6