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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434411600
Report Date: 03/11/2022
Date Signed: 03/11/2022 09:59:12 AM



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: 24DATE:
03/11/2022
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Erin MobleyTIME COMPLETED:
10:05 AM
ALLEGATION(S):
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10 - Neglect / Lack of Supervision
INVESTIGATION FINDINGS:
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On March 11, 2022 at approximately 8:55am LPA Haderer arrived to complete a follow up to the substantiated complaint and complete a Plan of Correction. LPA Haderer met with center director Ms. Mobley and discussed the plan. LPA and Ms. Mobley also toured the Pond room and the playgorund areas, there were 24 children and 6 staff present.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

California Code of Regulations, 101229(a)(1), are being cited on the attached LIC. 9099D.

An exit interview was conducted where the citation and plan of correction were discussed. Appeal rights were given and explained to the licensee. Notice of Site Visit was posted.


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: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
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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Control Number 52-CC-20211221102637
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTECITO SCHOOL
FACILITY NUMBER: 434411600
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/31/2022
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
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Center Director will hold an in-service or staff meetings to review when proper method of contact visual observation of children at all times, especially when they are in outside during outside play activities.

Center Director will prepare a meeting agenda and submit a copy to Licensing.
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This requirement was not met as evidenced by:
Based on reports from the Director and staff interviews, the licensee did not comply with the section cited above as there was an unobserved injury to a child that required medical treatment which poses a potential health, safety or personal rights risk to persons in care.
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The meeting will include a discussion about proper supervision, safety and personal rights of children. The meeting will include viewing CCLD videos: 1. Supervising Children in Child Care Center and 2. Children’s Personal Rights in Child Care. Meeting attendance sheets will be proved to CCLD
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2