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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343619934
Report Date: 04/21/2025
Date Signed: 04/21/2025 11:26:18 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/07/2025 and conducted by Evaluator Deborah Khashe
COMPLAINT CONTROL NUMBER: 53-CC-20250207091258
FACILITY NAME:ELK GROVE MONTESSORI SCHOOL (PS)FACILITY NUMBER:
343619934
ADMINISTRATOR:NELSON, SARAFACILITY TYPE:
850
ADDRESS:8842 WILLIAMSON DRIVETELEPHONE:
(916) 685-6540
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:107CENSUS: 78DATE:
04/21/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sara NelsonTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Neglect/Lack of Supervision: Staff do not properly supervise children leading to inappropriate interactions between day care children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs), Deborah Khashe and Jennie Tedlos conducted an unannounced field visit to deliver the findings for the above allegation. Both LPAs met with the Director Sara Nelson. LPAs disclosed the purpose of the inspection. LPAs toured the facility and observed (78) childcare children being supervised by (9) childcare teachers.
It was alleged that lack of supervision allowed children to engage in inappropriate interactions in the bathroom. During the investigation LPA Khashe toured the facility, observed staff interactions with and supervision of children in care, conducted interviews with teachers, parents, children, and reporting party, and obtained pertinent documents. One individual stated that staff did not supervise children directly while the children were in the bathroom. Staff 3 (S3) and Staff 4 (S4) admitted that they were assisting children in other areas of the classroom and were not aware that two children went into the bathroom. S3 was alerted that children were in the bathroom, when she heard laughter and found two children engaged in inappropriate play in the bathroom.
Report Continues on LIC-9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Deborah Khashe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
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 53-CC-20250207091258
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ELK GROVE MONTESSORI SCHOOL (PS)
FACILITY NUMBER: 343619934
VISIT DATE: 04/21/2025
NARRATIVE
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Based on corroborating information from interviews conducted, there is a preponderance of evidence to prove the alleged violation did occur at the facility. Therefore, the above allegation is found to be SUBSTANTIATED.

The following Title 22 Deficiency is being cited on the subsequent 9099-D page. Upon receipt of Type A citations, Director shall provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Director must also keep the signed LIC 9224, acknowledging receipt of LIC 9099-D in each child's file.

Appeal Rights were provided, and LPA posted a Notice of Site Visit and 9099-D page dated …. which must remain posted for 30 days.

Copy of this report was reviewed and provided to Director. Notice of site visit is posted and shall remain posted for next 30 days.

An exit interview was conducted with Director. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Deborah Khashe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 53-CC-20250207091258
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ELK GROVE MONTESSORI SCHOOL (PS)
FACILITY NUMBER: 343619934
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/21/2025
Section Cited
CCR
101229(a)(1)
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101229(a)(1)Resposibility for providing Care and Supervision (a) The Licensee shall provide care and supervision ...to meet the children's needs. (1) No Child(ren) shall be left without the supervision of a teacher at anytime... Supervision shall include visual observation. This requirement was not met as evidenced by:
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Staff meeting will be held to focus of supervision strategies. Director will email LPA with sign in sheet from this meeting. Director will email create a written statement for staff to sign that describes bathroom supervision for the future. Director will email the signed statement to the LPA.
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Based on the interviews, C2 admitted she did not directly supervise children while C1 and C2 were in the bathroom which posed an immediate health, safety, or personal rights risks to children in care.
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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: Bettina Engelman
LICENSING EVALUATOR NAME: Deborah Khashe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/07/2025 and conducted by Evaluator Deborah Khashe
COMPLAINT CONTROL NUMBER: 53-CC-20250207091258

FACILITY NAME:ELK GROVE MONTESSORI SCHOOL (PS)FACILITY NUMBER:
343619934
ADMINISTRATOR:NELSON, SARAFACILITY TYPE:
850
ADDRESS:8842 WILLIAMSON DRIVETELEPHONE:
(916) 685-6540
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:107CENSUS: 78DATE:
04/21/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sara NelsonTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not report incident to licensing.
INVESTIGATION FINDINGS:
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101212(d) (d) Upon the occurrence, during the operation of the childcare 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 information specified in (d) (2) below shall be submitted to the department within seven days following the occurrence of such event.

“This requirement has been met as evidence by” Elk Grove Montessori, facility # 343619934, by submitting an Unusual Incident Report LIC-624 via email on 2/5/2025.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Deborah Khashe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4