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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566214347
Report Date: 08/10/2023
Date Signed: 08/10/2023 01:20:41 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/02/2023 and conducted by Evaluator Elvin Baddley
COMPLAINT CONTROL NUMBER: 17-CC-20230802143839
FACILITY NAME:MONTESSORI OF THE VILLAGEFACILITY NUMBER:
566214347
ADMINISTRATOR:STEPHANIE CASE-FELIXSONFACILITY TYPE:
850
ADDRESS:30798 RUSSELL RANCH ROADTELEPHONE:
(818) 991-0720
CITY:WESTLAKE VILLAGESTATE: CAZIP CODE:
91362
CAPACITY:87CENSUS: 40DATE:
08/10/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Mayra GaetaTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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1. Facility staff did not provide child's authorized person notice of a type A violation
INVESTIGATION FINDINGS:
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On 8/10/23 at 11:30 AM, Licensing Program Analyst (LPA) Elvin Baddley made an unannounced inspection to the abovementioned Child Care Center (CCC) to investigate and deliver a finding with regard to the center failing to provide child's authorized representatives notice of a type A violation. LPA met with Mayra Gaeta, Assistant Director of the CCC, and explained the purpose of the inspection. Bishan Seneviratne, Administrator of the CCC, was included in the meeting via phone. LPA tour the interior and exterior of the CCC with the Assistant Director and observed 40 children in care, along eight staff members providing care and supervision.

The investigation included record reviews as well as interviews of the Complainant, Assistant Director and the Administrator.

The statements the LPA obtained from Complainant, the Assistant Director and the Administrator. corroborated each other. However, the contexts, intent and interpretation of each individuals statement (CONT. LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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 17-CC-20230802143839
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MONTESSORI OF THE VILLAGE
FACILITY NUMBER: 566214347
VISIT DATE: 08/10/2023
NARRATIVE
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differed. In essence, the CCC provided parents in care the narrative pages of and Facility Inspection Report (i.e. LIC 809 and LIC 809-C) as opposed to the report in its entirety (i.e. LIC 809, LIC 809-C and LIC 809-D).

Based on LPA's observation, interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Health and Safety (H&S) Code, Title 22 Division 6 and 1596.8595 is being cited on the attached LIC 9099 D page).

A closing interview was conducted with the Assistant Director. Assistant Director was provided and advised of their right to appeal (LIC 9058). LPA informed Assistant Director of the need to provide a plan of correction to CCLD as well as the time which the plan of correction needs to be submitted to CCLD.

The Notice of Site Visit (LIC 9213) was provided to Assistant Director as required by H&S Code Section 1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 17-CC-20230802143839
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MONTESSORI OF THE VILLAGE
FACILITY NUMBER: 566214347
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2023
Section Cited
HSC
1596.8595(c)(1)
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A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care. This was not met as the CCC
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CCC to provided entire Facility Inpsection Report of 7/27/23 (7 pages total) to all parents of children in care by 8/24/23.
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provided parents of children in care 3 pages of a 7 page reported isuued to the facility on 7/27/23, whereby type A deficenties were cited. This poses a potential risk to health, safety or personal rights of persons in care.
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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.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3