304270588-5-8-2024-06-CC-MMAE-D5NSXE-20240527141550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304270588
Report Date: 05/08/2024
Date Signed: 05/08/2024 10:42:29 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/15/2024 and conducted by Evaluator Anna Francesca Chan

COMPLAINT CONTROL NUMBER: 06-CC-20240315145717

FACILITY NAME:	IVYCREST MONTESSORI PRIVATE SCHOOL		FACILITY NUMBER:	304270588
ADMINISTRATOR:	TAKEDA, CLAIRE		FACILITY TYPE:	830
ADDRESS:	2025 E. CHAPMAN AVENUE		TELEPHONE:	(714) 879-6091
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92831
CAPACITY:	32	CENSUS: 10	DATE:	05/08/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Director Aida King		TIME COMPLETED:	10:55 AM

ALLEGATION(S):

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Facility did not provide parents with report of Type A citation

INVESTIGATION FINDINGS:

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On 5/8/2024, at 8:50am Licensing Program Analyst (LPA), Anna Chan conducted an unannounced Complaint investigation inspection. The purpose of the investigation is to deliver findings from a complaint initiated on 3/25/2024. Director for Preschool Dominque Bongcayao was also present during the inspection. Upon arrival, LPA met with Director, Aida King and informed the director of the purpose of the visit. LPA was led on a walk-through of the facility by the director and a census was taken. LPA observed 7 staff and 10 infant children.

A review of the Facility Personnel Report Summary shows all facility staff or individuals who require caregiver background checks have received a criminal record clearance and a child abuse index clearance or an exemption clearance.

The Department received a complaint on 03/15/24 alleging the facility did not provide parents with a report of Type A citation.
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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20240315145717

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IVYCREST MONTESSORI PRIVATE SCHOOL	FACILITY NUMBER: 304270588
	VISIT DATE: 05/08/2024

NARRATIVE

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On 03/25/2024, LPA Chan made an unannounced visit to the facility for the purpose of initial investigation about a complaint received on 3/15/24. During the visit, LPA reviewed 15 children’s files (including newly enrolled children). It was discovered that none of the 15 child files had a signed Acknowledgement of Receipt of Licensing Report (LIC 9224) form for the licensing report dated 02/15/2024.

On 03/25/24, Director, Aida King was interviewed, the director stated the facility did not provide the 02/15/24 licensing report LIC9099 and acknowledgement receipt LIC9224 to all infant families by the next business day. Director stated the facility sent a letter to the regional office requesting to hold providing LIC9224 to parents.

On 03/25/24, LPA stated that licensing report LIC9099 and acknowledgement receipt LIC9224 dated 2/15/24 should be provided to authorized representatives for signature within 24hrs or the next business day the child is in school.

On 5/8/24, LPA gathered documents such as, LIC9040 Children's Roster, Infant Sign in sheet for 5/8/24 as of 9:40am, facility enrollment list for infants. During today's visit, LPA reviewed 14 files without signed LIC9224.

Based on records reviewed, and interview conducted, it has been determined that the facility did not provide a copy of the report dated 02/15/24 by the next business day to the parents/guardians of children currently enrolled and newly enrolled. The preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Health and safety code 1596.8595 (c) is being cited on the attached LIC 9099D and civil penalty assessed.

Exit interview was conducted with Director Aida King. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above within 15 business days.

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SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 06-CC-20240315145717

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IVYCREST MONTESSORI PRIVATE SCHOOL	FACILITY NUMBER: 304270588
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/09/2024 Section Cited CCR 1596.8595(c)	1 2 3 4 5 6 7	1596.8595.(c) A licensed child care facility... shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citationThis requirement was not met as evidenced by. Based on records reviewed and	1 2 3 4 5 6 7	The director stated the facility is to provide a statement to LPA why the LIC9224 was not provided to parents. Facility is to provide copy of LIC9099 dated 02/15/24 that documents any Type A citation to parents/guardians of all children currently enrolled by the next businsess day or the next day
	8 9 10 11 12 13 14	interview, The facility did not provide the 02/15/24 licensing report LIC9099 and acknowledgement receipt LIC9224 to all infant families by the next business day. this poses an immediate risk to the health, safety, or personal rights of children in care.	8 9 10 11 12 13 14	children are in care, and to any newly enrolled parents/guardians for 12 months from the 2/15/24. Facility is to provide signed LIC9224 to LPA by 5/9/24. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must also be placed in the child's file for verification.
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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: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC9099 (FAS) - (06/04)

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