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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334846059
Report Date: 09/05/2023
Date Signed: 09/05/2023 10:55:31 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2023 and conducted by Evaluator Elyse Jones
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230828152322
FACILITY NAME:COUNTRYSIDE MONTESSORI ACADEMYFACILITY NUMBER:
334846059
ADMINISTRATOR:JAFFERY, KANEEZFACILITY TYPE:
850
ADDRESS:2266 GRIFFIN WAYTELEPHONE:
(951) 340-2821
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:78CENSUS: 33DATE:
09/05/2023
UNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Kaneez "Zainab" Jaffery, DirectorTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff do not accord dignity in his/her personal relationship with daycare child.
INVESTIGATION FINDINGS:
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On September 5, 2023, Licensing Program Analyst (LPA) Elyse Jones arrived at the facility to initiate and conclude the investigation regarding the above allegations. LPA conducted a tour of the facility inside only. During the investigation, LPA toured the facility, interviewed pertinent parties, and collected documentation.

On August 28, 2023, a complaint was received alleging a child was not accorded dignity in his/her personal relationship with staff when staff rolled their eyes and ignored a child during drop off.

LPA conducted interviews with all pertinent parties, including staff. Staff stated, the alleged incident ocurred when he/she first started working at the facility. The staff does not remember giving any inappropirate expressions to the child.

Due to conflicting statements given during interviews with pertinent parties, the Department is unable to determine if staff violated the child’s personal rights.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
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 09-CC-20230828152322
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: COUNTRYSIDE MONTESSORI ACADEMY
FACILITY NUMBER: 334846059
VISIT DATE: 09/05/2023
NARRATIVE
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This agency has investigated the complaint regarding the above allegation. Based on the interviews conducted, the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means although the allegations may have happened, or are valid, there is not a preponderance of the evidence to prove the allegations occurred.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Zainab Jaffrey, Director.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4