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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364841885
Report Date: 03/14/2023
Date Signed: 03/14/2023 03:03:16 PM

Substantiated


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
03/02/2023 and conducted by Evaluator Patricia Berry
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230302135601
FACILITY NAME:ST. MARY'S MONTESSORI SCHOOLFACILITY NUMBER:
364841885
ADMINISTRATOR:MARTINEZ DESERIEFACILITY TYPE:
850
ADDRESS:6880 N VICTORIA WINDROWS LOOPTELEPHONE:
(909) 200-2727
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY:209CENSUS: 162DATE:
03/14/2023
UNANNOUNCEDTIME BEGAN:
12:45 AM
MET WITH:Deserie Martinez/directorTIME COMPLETED:
03:30 AM
ALLEGATION(S):
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Child left in the classroom unattended during an emergency drill
INVESTIGATION FINDINGS:
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On 3/14/23 at 12:45 PM, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent complaint investigation. LPA met with director Deserie Martinez and was granted access into the facility. LPA toured facility and took a census.

It was alleged a child was left in the classroom unattended during an emergency drill in August of 2022. LPA interviewed all pertinent parties, including staff.
During interviews, it was revealed, while conducting an emergency drill on 08/11/22, at 9:00 am, staff left a child in a classroom, absent of supervision, under a table for approximately 5 minutes. Staff did not notice the child missing until staff were outside, in the parking lot, counting children. Administration staff admitted culpability to the incident occurring.


(Cont on 9099C)
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
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 3
Control Number 09-CC-20230302135601
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: ST. MARY'S MONTESSORI SCHOOL
FACILITY NUMBER: 364841885
VISIT DATE: 03/14/2023
NARRATIVE
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Based on staff interviews conducted and administration admitting culpability ,the above allegation, child left unattended during an emergency drill, is substantiated per California Code of Regulations 101229 (a) (1), Title 22, Division 12.

See LIC9099D for deficiency cited.

LPA Berry informed director Deserie Martinez today’s report documents a Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health and safety of children in care.
Also, LPA Berry informed director Deserie Martinez to provide a copy of this licensing report, dated 3/14/23 which documents a 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.

An exit interview was conducted, and appeal rights discussed. LPA Berry provided facility representative with a copy of this report, notice of site visit, and appeal rights.


Civil penalty LIC421IM for $1,000.00 issued today.

A copy of this report must be made available to the public upon request for three years.






SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Citations on this Visit Report are Under Appeal!

Control Number 09-CC-20230302135601
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: ST. MARY'S MONTESSORI SCHOOL
FACILITY NUMBER: 364841885
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
03/15/2023
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision...(1) No child shall be left without... supervision... ... shall include visual observation
This requirement was not met as evidenced by
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Teacher immediately retrieved the child from the classroom and notified the parent of the incident 8/11/22. Director stated she will conduct a training on supervision regarding procedure on emergency drills with all staff and send CCL the topic and a list of participants by 3/15/23.
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Based on staff interviews conducted and administration admitting culpability a child was left alone in a classroom.
This is an immediate risk to the health and safety of children care
Civil penalty LIC421IM for $1,000.00 issued today.
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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: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3