434415095-1-31-2024-07-CC-JSEA-D2E3EK-20240212171112

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434415095
Report Date: 01/31/2024
Date Signed: 01/31/2024 03:13:16 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2023 and conducted by Evaluator Samantha Yip

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20231113111449

FACILITY NAME:	ONE WORLD MONTESSORI SCHOOL, INC. LEIGH		FACILITY NUMBER:	434415095
ADMINISTRATOR:	KAREN BAMBERG		FACILITY TYPE:	850
ADDRESS:	4343 LEIGH AVENUE		TELEPHONE:	(408) 615-1254
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY:	67	CENSUS: 41	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Karen Bamberg		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff inappropriately touched child in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Manager (LPM) Joel Segura and Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation. LPM and LPA met with Director Karen Bamberg and explained the reason for the inspection. The purpose of this inspection is to deliver the findings of the above allegation and serve the Order to Facility of Immediate Exclusion from facility for S-1.

---------------CONTINUES ON 9099 DATED 01/31/2024 PAGE 2-------------

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 07-CC-20231113111449

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ONE WORLD MONTESSORI SCHOOL, INC. LEIGH	FACILITY NUMBER: 434415095
	VISIT DATE: 01/31/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

--------------CONTINUATION OF 9099 DATED 01/31/2024 PAGE 1--------------

The investigation of the above allegation was conducted by Community Care Licensing Division (CCLD) Investigator, Rhonda Austin. Based on interviews, record reviews, and evidence gathered during the investigation process, the Department determines staff inappropriately touched child in care to be SUBSTANTIATED, meaning the preponderance of the evidence standard has been met.

In addition to the above complaint, the facility also self-reported an incident on 06/23/2023 to the San Jose Regional office involving S-1 and another child also alleging inappropriate touching. Director stated that S-1 (See confidential names list, LIC 811 dated 01/31/2024) was placed on administrative leave.

LPM provided the notice of immediate exclusion for S-1 to Director Karen Bamberg.

As a result of this investigation, a Type A citation was issued. Exit interview conducted and report was reviewed with Director Karen Bamberg. A notice of site visit has been issued and must remain posted for 30 days.

LPA Samantha Yip informed Director Karen Bamberg that this report dated 01/31/2024 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Samantha Yip informed the facility representative to provide a copy of this licensing report dated 01/31/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 07-CC-20231113111449

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ONE WORLD MONTESSORI SCHOOL, INC. LEIGH	FACILITY NUMBER: 434415095
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/01/2024 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	Personal Rights. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The individual is excluded from all Community Care Licensed (CCL) facilities, and shall be removed.
	8 9 10 11 12 13 14	Based on interview and record reviews, S-1 inappropriately touched child(ren) in care, which posed an immediate health, safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14	The Licensee acknowledges this individual is excluded from the facility and cannot be present.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3