434416981-2-9-2022-07-CC-JSEA-CCHLRU-20220314085944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434416981
Report Date: 02/09/2022
Date Signed: 02/09/2022 01:00:43 PM

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
01/12/2022 and conducted by Evaluator Pietro Hernandez

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20220112160249

FACILITY NAME:	PIEDMONT HILLS MONTESSORI ACADEMY		FACILITY NUMBER:	434416981
ADMINISTRATOR:	MICHELLE CONLON		FACILITY TYPE:	850
ADDRESS:	1425 OLD PIEDMONT ROAD		TELEPHONE:	(408) 923-5151
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY:	65	CENSUS: 28	DATE:	02/09/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Susana Mora		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Day care did not provide new admission agreement

INVESTIGATION FINDINGS:

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On 02/9/2022: Licensing Program Analyst (LPA) Pietro Hernandez conducted an unannounced Subsequent Complaint Investigation at the facility. LPA spoke with Susana Mora and discussed the finding for the above allegation.

During the course of the investigation, LPA inspected the Child Care Center, reviewed records, and conducted interviews with the Director, Teachers, helpers, and parents. LPA Hernandez determined that the alligation is Substanciated.

Continued on page 2 of LIC9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

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-20220112160249

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: PIEDMONT HILLS MONTESSORI ACADEMY	FACILITY NUMBER: 434416981
	VISIT DATE: 02/09/2022

NARRATIVE

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Continuation of Page 1 LIC9099
Allegation:

1) Day care did not provide new admission agreement. LPA Hernandez observed that the new facility ownership purchased the day-care center last year in June of 2022 but did not provide new admission agreements to the parents or legal guardians of the children whom continued to stay enrolled with the facility after the change of ownership. New admission agreements were completed and provided to the new enrolled children's parents or legal guardians after the purchase but not to the continuing enrolled. LPA did collect documentation to verify how the admission agreements were handled before and after the purchase and the initial visit to investigate.
It is important to note that the new ownership has updated and provided new admission agreements to the parents and legal guardians since the LPA's first visit on 1/19/2022. However, the allegation is still Substantiated.

Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation: is SUBSTANTIATED

A deficiency is being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22 An exit interview was conducted with the Licensee. A copy of this report and appeals rights were discussed and left with the Licensee, Susana Mora, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 07-CC-20220112160249

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: PIEDMONT HILLS MONTESSORI ACADEMY	FACILITY NUMBER: 434416981
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/09/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/10/2022 Section Cited CCR 101219(a)	1 2 3 4 5 6 7	Admission Agreement (a) The licensee and the child's authorized representative shall jointly complete a current individual written admission agreement for the child. This documentation shall be maintained at the child care center and shall be available for review. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	BY POC DUE DATE: Director will obtain updated admission agreements for all the parents and legal gaurians of the enrolled children. This was done prior to the LPA's arrival to deliver findings.
	8 9 10 11 12 13 14	Per LPAs review of the files: The LPA observed that the previous owners admission agreements were being reused and were never updated when the new ownership took aver and operated under a new license.	8 9 10 11 12 13 14
	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) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3