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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393600441
Report Date: 11/17/2022
Date Signed: 11/17/2022 02:31:13 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2022 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20221028104856

FACILITY NAME:MONTESSORI SCHOOL OF TRACYFACILITY NUMBER:
393600441
ADMINISTRATOR:TERESA MORENOFACILITY TYPE:
850
ADDRESS:100 SOUTH TRACY BOULEVARDTELEPHONE:
(209) 833-3458
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:240CENSUS: 139DATE:
11/17/2022
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Teresa Moreno TIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Staff did not properly report outbreak
INVESTIGATION FINDINGS:
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On November 17, 2022, Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of delivering complaint findings. LPA met with Facility Representative. LPA observed 139 children supervised by 16 staff ( 8 rooms ) .

It was alleged that Staff did not properly report an outbreak of hand- foot- mouth virus. An investigation was conducted which consisted of a facility inspection, review of evidence and pertinent documentation and interviews with facility staff and parents. Attempts were made to contact the reporting party; however, there was no response. Information received revealed parents with children in the classroom of the diagnosed children were notified of the exposure. Going forward, the Director has agreed to notify the entire school if potential exposure occurs. Based on the information received, the allegation is determined unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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 4
Control Number 53-CC-20221028104856
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: MONTESSORI SCHOOL OF TRACY
FACILITY NUMBER: 393600441
VISIT DATE: 11/17/2022
NARRATIVE
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No Title 22 deficiencies have been cited for this complaint.

An Exit Interview was conducted in which the report was reviewed and discussed with Facility Representative, Teresa Morreno. Appeal rights provided. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4