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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198011204
Report Date: 03/02/2023
Date Signed: 03/02/2023 05:46:27 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2023 and conducted by Evaluator Carolyn Tuba
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20230223165124
FACILITY NAME:INTERNATIONAL MONTESSORI PRESCHOOLFACILITY NUMBER:
198011204
ADMINISTRATOR:LAURIE SEGURAFACILITY TYPE:
850
ADDRESS:211 E. ARROW HWYTELEPHONE:
(909) 399-9222
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:48CENSUS: 29DATE:
03/02/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Yolanda MenaTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Facility is operating out of ratio
Staff do not properly supervise daycare children
Staff places swaddle on child during nap time
INVESTIGATION FINDINGS:
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On 3/2/2023 at 09:15 a.m., Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced complaint inspection to investigate and deliver findings of the above allegations. A Covid risk assessment was conducted when entering the facility. LPA met with Staff (S1), who is acting Director due to the Director, Laurie Segura being out on leave. S1 guided LPA on a tour of the facility. There was a total of 29 children present with 4 staff.
Complainant alleged that Facility is operating out of ratio and staff do not properly supervise daycare children and staff places swaddle on child during nap time. Based on Staff interviews, LPA observations, records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. At this time, a deficiency is being cited of 2 Type A’s and 1 Type B.
Care and Supervision: LPA observed when she first arrived at 9:20 am children were hiding near the restrooms located outside of their classrooms inside the facility, unsupervised, as well as children running out of the classrooms to grab water bottles and their personal items from backpacks that were hanging in the inside hallway of the facility. LPA conducted interviews with Staff #1 (S1), #2 (S2), and #3 (S3), S2 and S3
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
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 4
Control Number 33-CC-20230223165124
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: INTERNATIONAL MONTESSORI PRESCHOOL
FACILITY NUMBER: 198011204
VISIT DATE: 03/02/2023
NARRATIVE
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during their interviews did state that they are occasionally left out of ratio during the morning time until additional staff arrives. Staff stated that if children need to be taken to the restroom, which is located down the hall of the classroom or have to use the restroom themselves, they have been out of ratio. During the visit LPA observed children in a classroom located by the restrooms, which was empty and unsupervised, and children were wandering outside of staff’s view. During the course of the investigation, LPA conducted records review and found that S2 does not have on file any certificate or transcripts indicating S2 is a fully qualified teacher. During the course the visit, LPA observed S2 alone with 2 children right before nap time with a few children sill eating lunch and, in the restroom, changing a child and with 2 other children. Based on the qualification of S2 and S3, the maximum number of children that could be supervised is 15 and during LPA's initial census found they had 16 children in care. Therefore, the facility was found that they were operating out of ratio on the day of inspection.

Nap time Activities: LPA conducted interviews and S3 disclosed of a child who uses a sleeping sack during nap time and described the arms are restricted. LPA was able to observe sleeping sack and obtain photos, which clearly restrict movement of child when napping, as sleeves are zipped up to be removed but was confirmed by staff, that child sleeps with them zipped-up. LPA advised Staff that a doctor's note would be needed for medical reason and exemption would be requested to the Department for prior approval.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 12, Chapter 1, the following deficiency is being cited (see attached 9099D).

LPA explained that a copy of any licensing report that documents a Type A citation(s) must be provided to the 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. LPA provided one copy of the Acknowledgement of Receipt of Licensing Report (LIC 9224), which requires parent signature or other written statement, must be placed in the child's file for verification.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview was conducted with Teacher, Yolanda Mena, copy of this report given along with appeal rights were provided.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20230223165124
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: INTERNATIONAL MONTESSORI PRESCHOOL
FACILITY NUMBER: 198011204
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/06/2023
Section Cited
CCR
101216.3(b)(1)
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A ratio of one fully qualified teacher (as specified in Section 101216.1(c) and one aide for every 18 children in attendance in a preschool program is allowed when the aide meets the qualifications specified in Section 101216.2(d).
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Staff will speak to Owner to have additional perdson who is qualified to sub while inquiring of staff qualifications. Staff will adjust ratio as needed.

LPA will do follow-up visit.
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To receive safe, healthful ... This requirement was not met as evidence by:LPA conducted interviews with staff which indicated being left out of ratio and LPA reviewed records and observed staff alone with children who lacks the qualifications needed.
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Type A
03/06/2023
Section Cited
CCR
101229(a)(1)
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The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Staff has agreed to place backpacks, water bottles and personal items of children inside of classrooms to keep children from wandering unsupervised. Staff will be hiring an extra staff and will temporarily have a sub to assist with supervision for bathroom and
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To receive safe, healthful ... This requirement was not met as evidence by: LPA observed children being unsupervised inside the facility and running to restrooms and to obtain personal items, such as water bottles and backpacks.
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other school activities. Empty classroom near bathroom will be made inaccessible to children with child safety latch. Staff will be sending notification to parents to notifiy them to use code and pick-up their child inside facility and this will assist staff so they do not have to open door to parents.
LPA will do follow-up visit
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: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20230223165124
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: INTERNATIONAL MONTESSORI PRESCHOOL
FACILITY NUMBER: 198011204
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2023
Section Cited
CCR
101430(c)
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An infant shall not be swaddled while in care.
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Staff will speak to parent explain that it cannot be used at the facility and return sleeping sack. LPA advised Staff that a doctor's note is needed and exemption requested to the Licensing Department for prior approval.
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To receive safe, healthful ... This requirement was not met as evidence by: staff interviews confirming the use of sleeping sack and restricting arms of child and LPA observed and obtain photos.
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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: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4