<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 573615117
Report Date: 06/08/2022
Date Signed: 06/08/2022 01:31:45 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/06/2022 and conducted by Evaluator Erwin Tjhia
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220606085448
FACILITY NAME:PORTSIDE MONTESSORIFACILITY NUMBER:
573615117
ADMINISTRATOR:HERNANDEZ, M. SMITH, M.FACILITY TYPE:
850
ADDRESS:2700 LINDEN ROADTELEPHONE:
(916) 224-2033
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:84CENSUS: 21DATE:
06/08/2022
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Rachel DelgadoTIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is providing care beyond the terms of their license.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts Tjhia and Hunters met with the director, Rachel Delgado, and assistant director, Samia Abbushi to open and close complaint investigation regard the above allegation.

During the inspection, LPAs inspected the classrooms and reviewed faciity's records. LPAs also interviewed the present staffs. Based on the interviews and review of records that revealed facility had a child enrolled in toddler program that did not meet the age requirement. Director stated that children allowed to transition into the toddler's clasroom to meet the teacher and to learn the classroom's routines. Based upon this, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22 regulations are being cited on the attached 9099-D page

Copy of this report was reviewed and provided to director. Notice of site visit is posted and shall remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
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 2
Control Number 53-CC-20220606085448
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: PORTSIDE MONTESSORI
FACILITY NUMBER: 573615117
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2022
Section Cited
CCR
101161(a)
1
2
3
4
5
6
7
101161 Limitations on Capacity
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement was not met as evidence by
1
2
3
4
5
6
7
Director stated that she will request the exception from the licensing office when transitioning children over to the toddler program prior to them turn in to 18 months. Director will also do this for all future transitions.
8
9
10
11
12
13
14
Based on LPAs observation,interview and record review it was determine that a 16 months old child was enroll in toddler component prior being 18 months. This is a potential health and sefety risk to children in care.
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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2