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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434411600
Report Date: 12/23/2021
Date Signed: 12/23/2021 04:11:23 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/21/2021 and conducted by Evaluator Russell Haderer
COMPLAINT CONTROL NUMBER: 52-CC-20211221102637
FACILITY NAME:MONTECITO SCHOOLFACILITY NUMBER:
434411600
ADMINISTRATOR:ERIN K. MOBLEYFACILITY TYPE:
840
ADDRESS:1468 GRANT ROADTELEPHONE:
(650) 968-5957
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY:24CENSUS: 25DATE:
12/23/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Erin MobleyTIME COMPLETED:
04:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
10 - Neglect / Lack of Supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On December 23, 2021 at approximately 10:00am LPA Haderer arrived to open the complaint and conduct an investigation. Upon arrival, the center director Erin Mobley was not present, but only 10 minutes away. LPA Haderer spoke with Ms. Mobley by cell to discuss the nature of the visit, she arrived within 10 minutes and the in-person interview continued. The director stated she did not see the accident when it happened. She came across the child sitting on the ground leaning on the fence and a little teary eyed. She asked the child what happened but the child is shy and would not say. He then told the teachers he hit his head on a bench.

The injured child was enrolled in the Pond classroom. LPA toured the facility with the director, took photos of the area the incident occurred and also the rear area playground area and the Pond room.
LPA interviewed the staff and all confirmed the child is very shy but was fine that morning. Although all the staff were present, staff were supervising the children, they confirmed that no one saw the child fall or hit his head.
The complaint is substantiated - Neglect/Lack of Supervision - unobserved injury to a child that required medical treatment.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
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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