380503970-1-18-2022-05-CC-AZEA-CAUQCS-20220120110336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 380503970
Report Date: 01/18/2022
Date Signed: 01/18/2022 12:33:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/05/2021 and conducted by Evaluator Cindy Mok

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20211005121141

FACILITY NAME:	MONTESSORI CHILDREN'S HOUSE OF THE WEST COAST		FACILITY NUMBER:	380503970
ADMINISTRATOR:	ELLIOTT, GRACE		FACILITY TYPE:	850
ADDRESS:	25 LAKE STREET		TELEPHONE:	(415) 221-4624
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY:	60	CENSUS: 35	DATE:	01/18/2022
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Grace Elliott		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff inappropriately touching a child in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts(LPAs) Mok conducted an unannounced inspection to finalize this complaint. This complaint was investigated by CDSS Investigations Branch Investigator, Guerra. LPA met with the Site Director, Grace Elliott. The purpose of the inspectino was explained to her. There were 35 children with 7 staff present.

Based on the investigations conducted by investigator Guerra on the allegations of staff inappropriately touching a child in care mentioned above, the allegation may have happened or was valid. There was not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegation was UNSUBSTANTIATED.An exit inspection was conducted with the site director.

An exit inspection was conducted with the site director, and appeal rights were explained. A printed copy of the report, as well as a printed copy of the appeal rights, were provided to the site director. Notice of site visit must remain posted for 30 days for public review.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022

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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