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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 573615117
Report Date: 01/12/2024
Date Signed: 01/12/2024 02:17:38 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/14/2023 and conducted by Evaluator Erwin Tjhia
COMPLAINT CONTROL NUMBER: 53-CC-20231214082834
FACILITY NAME:PORTSIDE MONTESSORIFACILITY NUMBER:
573615117
ADMINISTRATOR:MELINDA H. & MAUREEN S.FACILITY TYPE:
850
ADDRESS:2700 LINDEN ROADTELEPHONE:
(916) 372-7838
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:84CENSUS: 69DATE:
01/12/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Rachel DelgadoTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Staff negligence resulted in daycare children communicating with an unknown adult
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erwin Tjhia met with Director, Rachel Delgado to deliver findings of the complaint investigation regarding the above allegation.

During the investigation, LPA conducted interviews, and obtained pertinent information. It was alleged that staff negligence resulted in daycare children communicated and interacted with an unknown adult. During interviews LPA learned that the children were asking an unknown individual to pass the pinecones from the other side of the fence when they were playing outside. It also revealed that staff were aware of the situation and allowed the unknown individual to hand the pinecones to the children.

Based on the interviews and review of records the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The following Title 22 Deficiency is being cited on the subsequent 9099-D pages.
Report Continue on 9099-C
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: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
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 53-CC-20231214082834
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PORTSIDE MONTESSORI
FACILITY NUMBER: 573615117
VISIT DATE: 01/12/2024
NARRATIVE
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Upon receipt of Type A citations, Director shall post and provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Director must also keep the signed LIC 9224, acknowledging receipt of LIC 9099-D in each child's file. Appeal Rights was provided and Notice of Site Visit was posted.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20231214082834
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PORTSIDE MONTESSORI
FACILITY NUMBER: 573615117
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
01/13/2024
Section Cited
CCR
101223(a)(2)
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101223(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings, and equipment to meet his/her needs.
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Director shall submit a written plan outlining steps she is taking to ensure that the personal rights of all children is being ensured, and that the environment is safe and comfortable for all children at the facility.
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This requirement was not met as evidenced by: LPA learned that the facility staff did not prevent the day care children from communicating and interacting with an unknown adult. This is an immediate health and safety risk to children 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.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3