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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013423772
Report Date: 04/23/2026
Date Signed: 04/23/2026 04:07:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/18/2026 and conducted by Evaluator Kareeca Sykes
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20260218081649
FACILITY NAME:GRAND LAKE MONTESSORIFACILITY NUMBER:
013423772
ADMINISTRATOR:ALICIA COOPERFACILITY TYPE:
860
ADDRESS:466 CHETWOOD STREETTELEPHONE:
(510) 836-4313
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY:195CENSUS: 15DATE:
04/23/2026
UNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Leta KoerberTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Staff fed the wrong bottle to infant in care
INVESTIGATION FINDINGS:
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On 04/23/2026 at 1:26PM Licensing Program Analyst’s (LPA’s) Kareeca “Reeca” Sykes and Mone Flores conducted an Unannounced Subsequent Complaint Investigation at Grand Lake Montessori. LPAs met with the facilities Director of Programs and Curriculam, Leta Koerber and explained purpose of the visit. LPA’s observed 15 infants in two (2) classrooms with four (4) staff. Director of Programs informed LPA’s that there is currently 19 infants enrolled at the facility. Complainant alleges that “Staff fed the wrong bottle to infant in care”. During the course of the investigation, LPA’s inspected the facility, reviewed records and conducted interviews. LPA also recieved a self reported incident to the department on 01/22/2026. It was determined that S1 fed C1, C2's bottle which contains breastmilk.

Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.
Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Kareeca Sykes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
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 4
Control Number 02-CC-20260218081649
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GRAND LAKE MONTESSORI
FACILITY NUMBER: 013423772
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/24/2026
Section Cited
CCR
101427(c)
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101427(c) Infant Care Food Service ... (c)
The infant shall be fed in accordance with the individual plan. This requirement has not been met as evidenced by: Based on interviews, and documents obtained the facility did not comply with the section cited above when S1 did not verify the correct bottle and...
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By 04/24/2026, Director of Programs stated the facility will talk to staff and submit statement on how the facility will remain in compliance to prevent these incidents from happening again. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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.. fed C1 almost half of the bottle containing breastmilk that belonged to C2 which poses an immediate risk to the health, safety or personal rights of 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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Kareeca Sykes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 02-CC-20260218081649
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: GRAND LAKE MONTESSORI
FACILITY NUMBER: 013423772
VISIT DATE: 04/23/2026
NARRATIVE
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LPA's informed the licensee that this report dated 04/23/26 document(s) one (1) Type A citations 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. LPA's also informed the licensee to provide a copy of this licensing report dated 04/23/26 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.


Exit interview was conducted with the Director of Programs and Curriculam, Leta Koerber. Appeal rights were provided. A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Kareeca Sykes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4