<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371474
Report Date: 07/18/2024
Date Signed: 07/18/2024 10:37:10 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 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
04/26/2024 and conducted by Evaluator Giselle Lucero
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20240426131217
FACILITY NAME:BUENA PARK MONTESSORI ACADEMYFACILITY NUMBER:
304371474
ADMINISTRATOR:ROXANA C. DOMINGUEZFACILITY TYPE:
850
ADDRESS:6221 LINCOLN AVENUETELEPHONE:
(714) 821-7800
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:78CENSUS: 33DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Director Roxana DominguezTIME COMPLETED:
09:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Daycare child’s hair was pulled out by another daycare child in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Giselle Lucero and Aiddee Nunez conducted an unannounced complaint inspection to deliver the findings for the above allegation. This is a continuation of the investigation initiated on 05/02/2024. Upon arrival LPA met with Director Roxana Dominguez. Director guided LPA on a walkthrough of the facility. At 8:45 AM LPAs observed a total of 33 preschool children with 5 staff.

A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The Department received a complaint on 04/26/2024 alleging a daycare child’s hair was pulled out by another daycare child on 04/10/2024 and on 04/23/2024, resulting in child sustaining a bald spot.

(continue to page 2)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Giselle LuceroTELEPHONE: 714-292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 4
Control Number 06-CC-20240426131217
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BUENA PARK MONTESSORI ACADEMY
FACILITY NUMBER: 304371474
VISIT DATE: 07/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Page 2)
During the investigation LPA Lucero interviewed the RP, 6 staff, obtained documents, obtained medical records, and reviewed the facility roster. During the investigation, LPA observed there were video cameras at the facility. LPA requested video footage of the day of the incident. Director stated the video footage is not recorded.

During staff interview conducted on 05/02/2024, 5 out of 6 staff interviewed stated they were aware of a incident where Child #1 (C1) pulled Child #2’s (C2) hair out while on the playground, which resulted in C2 sustaining a bald spot on their scalp.

During the staff interviews, Staff #2 (S2) disclosed they were present on the play yard the day of the incident. S2 stated they had just returned from their break and a child had a bloody nose. S2 was attending to the child when they heard a scream. S2 went towards the scream and saw C1 and C2 behind the playground structure. S2 saw C2 with their hair messed up and crying. S2 comforted C2 and asked what happened. C2 disclosed that C1 had pulled their hair. When S2 checked on C2’s hair, some of C2’s hair had fallen off into S2’s hand. S2 stated a dime size bald spot was observed on C2’s scalp. S2 stated the Director and parents of both parties were notified of the incident. S2 stated staff are supposed to be spread out on the playground to maintain supervision. Picnic tables on the play yard were moved to encourage staff to spread out and prevent staff from sitting down together. S2 disclosed staff would want to congregate at the picnic tables instead of moving around and the Director would always go out there if she saw staff sitting and would tell them to move around. S2 stated they are unaware if C2 had another hair pulling incident but disclosed seeing C2’s head and noticed other bald spots.

Staff #6 (S6) stated C2's parents had inquired if another hair pulling incident had occured because C2 was observed with a bigger bald spot. S6 stated all staff were asked if they were aware of another hair pulling incident and no disclosures were made. S6 stated they are not sure if the bald spot had occured here at the facility.


(Continue to page 3)
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Giselle LuceroTELEPHONE: 714-292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 06-CC-20240426131217
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BUENA PARK MONTESSORI ACADEMY
FACILITY NUMBER: 304371474
VISIT DATE: 07/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Page 3)
Based on LPA’s interviews conducted, medical records and pictures obtained, it has been determined daycare child’s hair was pulled out by another daycare child in care due to lack of supervision. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Responsibility for Providing Care and Supervision section 101229(a)(1) is being cited on the attached LIC 9099D.

LPA Giselle Lucero informed Director Roxana Dominguez, that this report dated 07/18/2024 documents 1 Type A citation 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. Also, LPA Giselle Lucero informed Director Roxana Dominguez, to provide a copy of this licensing report dated 07/18/2024 that documents any Type A citation 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 conducted and report was reviewed with the Director Roxana Dominguez. 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.

Appeal Rights were explained. The Director 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.

End of Report.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Giselle LuceroTELEPHONE: 714-292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 06-CC-20240426131217
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BUENA PARK MONTESSORI ACADEMY
FACILITY NUMBER: 304371474
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2024
Section Cited
CCR
101229(a)(1)
1
2
3
4
5
6
7
101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision...(1) No child(ren) shall be left without the supervision.... Supervision shall include visual observation. This requirement was not met as evidence by:
1
2
3
4
5
6
7
Director stated picnic tables were rearranged around the playyard to ensure supervision is being met on all areas of the play yard and they also had a staff meeting on 07/11/2024 regarding active supervision. LPA obtained a copy of staff sign in sheets for staff present for the 07/11/2024 meeting.
8
9
10
11
12
13
14
Based on LPA’s interviews conducted, medical records and pictures obtained, it has been determined daycare child’s hair was pulled out by another daycare child in care due to lack of supervision. This poses an immediate health and safety risk to the children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Giselle LuceroTELEPHONE: 714-292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4