393621606-2-24-2021-53-CC-JSMH-BX928J-20210113161022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 393621606
Report Date: 11/12/2020
Date Signed: 02/24/2021 01:11:29 PM

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
08/12/2020 and conducted by Evaluator Aruna Sridharan

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20200812150558

FACILITY NAME:	STOCKTON MONTESSORI SCHOOL		FACILITY NUMBER:	393621606
ADMINISTRATOR:	WANG, LILI		FACILITY TYPE:	850
ADDRESS:	1606 HAMMERTOWN DRIVE		TELEPHONE:	(209) 954-9793
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95210
CAPACITY:	119	CENSUS: 3	DATE:	11/12/2020
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Lili Wong		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Physical Plant

INVESTIGATION FINDINGS:

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This is an amended report due to a change of the Administrator.

Licensing Program Analyst (LPA) Aruna Sridharan spoke with Director Lili Wang to deliver the findings via facetime due to COVID-19 State of Emergency Order. According to the complainant, the facility does not regulate hot water. During the investigation, it was determined that the staff was aware and the licensee was working to get the faucet fixed. Based on the information obtained through interviews and documentation, the above allegation could not be substantiated. 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, therefore the finding is UNSUBSTANTIATED.
An exit interview was conducted in which the report was reviewed and discussed with licensee. Appeal rights were explained and printed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2020

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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