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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370799
Report Date: 02/11/2022
Date Signed: 02/11/2022 03:05:12 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/16/2021 and conducted by Evaluator Pat Rivas
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20211116121533
FACILITY NAME:MONTESSORI INTERNATIONAL ACADEMYFACILITY NUMBER:
304370799
ADMINISTRATOR:ENOMOTO, YUKARIFACILITY TYPE:
850
ADDRESS:2717 SOUTH HALLADAY STREETTELEPHONE:
(714) 444-2733
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:114CENSUS: 81DATE:
02/11/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maki Kobayashi, DirectorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff pinched a daycare child while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Rivas conducted a complaint visit to render findings for the above allegations. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearances or exemptions and a child abuse index clearance. A Facility Risk assessment was conducted to determine the level of Personal Protective Equipment (PPE) was needed for an on-site inspection. LPA observed staff wearing masks indoors.
On 11/16/21 the Regional Office received a complaint alleging 1) Staff pinched a daycare child while in care
The investigation consisted of; interview with 4 staff, and 5 families, interview with children, review of facility records.

In reference to the allegation that staff (S1) pinched a daycare child while in care on 11/03/21; Interview with Principal Sumiyo Sumikawa reported that the facility was made aware of the allegation by Child #1(C1)’s parents on 11/03/21, during a parent teacher conference. On 11/04/21 Principal Sumikawa had a meeting with C1’s parent and C1’s teachers (S1 and S2). In meeting S1 and S2 denied pinching or hurting C1 and denied knowledge of marks. On 11/22/21 S1 & S2 denied pinching or hurting or leaving marks on C1. On 11/04/21 C1 was interviewed by Principal in presence of S1 and S2 and Director Enomoto
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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 5
Control Number 06-CC-20211116121533
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI INTERNATIONAL ACADEMY
FACILITY NUMBER: 304370799
VISIT DATE: 02/11/2022
NARRATIVE
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LPA was shown video of interview in which C1 changes how he was hurt. LPA reviewed records provided including note dated 11/17/21 , which states “L arm bruise/a/p. possible intentional pinch…” Note dated 11/17/21 indicated;”11/03/21…bruise/scratch L arm no “booboo” reports “teacher…. Pinched me.” Police reports were requested from Santa Ana Police Department who referred to Superior Court of California County of Orange, Lamoreaux Justice Center who in turn reported there was no report filed. Interview with C1’s parents indicate that Police Dept did go out but advised them there would be no further investigation. C1’s parents also indicate that C1 has been consistent with reporting who caused marks/bruises. LPA interviewed C1 but C1 did not state who pinched him. LPA interviewed 2 of 5 children in C1’s classroom. Interviews with two children did not divulge any personal rights violations. 3 of the 5 children could not be qualified for interviews. Interview with 5 families indicated there were no issues or concerns. LPA could not corroborate the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.



An exit interview was conducted with Director, Kobayashi. Appeal Rights were explained. The licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/16/2021 and conducted by Evaluator Pat Rivas
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20211116121533

FACILITY NAME:MONTESSORI INTERNATIONAL ACADEMYFACILITY NUMBER:
304370799
ADMINISTRATOR:ENOMOTO, YUKARIFACILITY TYPE:
850
ADDRESS:2717 SOUTH HALLADAY STREETTELEPHONE:
(714) 444-2733
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:114CENSUS: 81DATE:
02/11/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maki Kobayashi, DirectorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not properly report an incident involving a daycare child
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Rivas conducted a complaint visit to render findings for the above allegations. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearances or exemptions and a child abuse index clearance. A Facility Risk assessment was conducted to determine the level of Personal Protective Equipment (PPE) was needed for an on-site inspection. LPA observed staff wearing masks.

On 11/16/21 the Regional Office received a complaint alleging Staff did not properly report an incident involving a daycare child.

The investigation consisted of; interview with 4 staff, and 5 families, review of facility records.
Interview with; Principal Sumiyo Sumikawa reported that the facility was made aware of the allegation by Child #1(C1)’s parents on 11/03/21, during a parent teacher conference. Report was made by mother to

Cont. on 9099c
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 06-CC-20211116121533
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI INTERNATIONAL ACADEMY
FACILITY NUMBER: 304370799
VISIT DATE: 02/11/2022
NARRATIVE
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9099c

S1 and S2. On 11/04/21 Principal Sumikawa had a meeting with C1’s parent and C1’s teachers (S1 and S2). Principal reports she did not file an Unusual Incident Report to Community Care Licensing (CCL) until 11/15/21 because “…she did not have reasonable suspicions or observations of any incident in which C1 was pinched or harmed in any way by our teacher…” On 11/15/21 she had been contacted by Santa Ana PD and therefore made a report to Community Care Licensing Division (CCL) and Child Protective Services (CPS). Interview with S1 and S2 indicated they did not advise C1's parents of marks or bruises because they were unaware of them. The Regional Office Received an Unusual incident report on 11/15/21.

Based on LPAs observations and interviews which were conducted record review(s), 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 and Chapter 1 are being cited on the attached LIC 9099D.

An exit interview was conducted with Director, Kobayashi. Appeal Rights were explained. The licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 06-CC-20211116121533
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI INTERNATIONAL ACADEMY
FACILITY NUMBER: 304370799
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/18/2022
Section Cited
CCR
101212(d)1(D)
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Reporting Requirements;Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the info . specified in (d)(2) below shall be submitted
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Director and principal will obtain follow up mandated reporter training and provide LPA Rivas with copy of certificates by plan of correction date.
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 to the Department within seven days following the occurrence of such event. Including;:Any suspected physical or psychological abuse of any child.This requirement was not met as evidenced by Principal's statement that report was not filed until 11/15/21 because she did not suspect any abuse. This poses a potential risk to children.
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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: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5