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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374845328
Report Date: 11/09/2022
Date Signed: 11/09/2022 05:18:31 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 STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2022 and conducted by Evaluator Andrea Taylor
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20221006165811
FACILITY NAME:PEPPERTREE MONTESSORIFACILITY NUMBER:
374845328
ADMINISTRATOR:HOWARD, KAYLAFACILITY TYPE:
850
ADDRESS:427 COLLEGE WAY, STE ITELEPHONE:
(760) 940-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:92CENSUS: 22DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:Cheryl Gillins - DirectorTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Personal Rights-A staff member picked an child up and moved child to different side of the room
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Taylor conducted a complaint inspection on today's date due to a complaint received in the licensing office on 10/7/22. LPA Taylor toured the facility, inside and out. Census was taken. There were 36 preschool children and 7 staff present during this inspection. A review of staff criminal clearance records on 11/9/22 indicates that all facility staff or other individuals who require caregiver background checks have received.
During a prior complaint inspection conducted on 10/12/22 LPA Taylor interviewed staff and children, obtained a current children’s roster.
On October 6, 2022 this agency received an allegation that a childcare staff inappropriately disciplined a child while in care. Confidential interviews disclosed that this staff member picked child up, walked with child across the room and sat child down in a chair. Other confidential interviews and record reviews confirmed the incident occurred. It was revealed that this staff member not the staff who was supervising the child at this time. Regulations state that corporal punishment and other humiliating, or frightening techniques are prohibited.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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 7
Control Number 10-CC-20221006165811
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: PEPPERTREE MONTESSORI
FACILITY NUMBER: 374845328
VISIT DATE: 11/09/2022
NARRATIVE
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Page 2

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, 101223-Personal Rights (a)(3) is being cited on the attached LIC 9099D.

In the areas that were evaluated, the facility was not in compliance and violation, in accordance with California Code of Regulations, Health & Safety 1596.7995(a)(1), is being cited on the attached LIC 809D.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

If the facility receives a Type A violation, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days, and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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 STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2022 and conducted by Evaluator Andrea Taylor
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20221006165811

FACILITY NAME:PEPPERTREE MONTESSORIFACILITY NUMBER:
374845328
ADMINISTRATOR:HOWARD, KAYLAFACILITY TYPE:
850
ADDRESS:427 COLLEGE WAY, STE ITELEPHONE:
(760) 940-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:92CENSUS: 22DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:Cheryl Gillins - DirectorTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Reporting Requirement-Incident was not reported to parent
INVESTIGATION FINDINGS:
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On the date and time listed, Licensing Program Analyst (LPA) Andrea Taylor arrived at the facility for the purpose of delivering the complaint finding regarding the investigation of the above-referenced allegation. On October 7, 2022, Community Care Licensing (CCL) received a complaint alleging that facility failed to meet reporting requirements.

An initial 10-day visit was conducted on October 12, 2022. LPA conducted interviews with staff members, and LPA obtained pertinent documents/information regarding the investigation.

It was disclosed during interviews an child's personal rights were violated by a staff member and the parents were not notified.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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 7
Control Number 10-CC-20221006165811
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: PEPPERTREE MONTESSORI
FACILITY NUMBER: 374845328
VISIT DATE: 11/09/2022
NARRATIVE
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Page 2

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
In the areas that were evaluated, the facility was not in compliance and violation, in accordance with California Code of Regulations, Health & Safety 1596.7995(a)(1), 101212-Reporting Requirements is being cited on the attached LIC 9099D.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 10-CC-20221006165811
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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: PEPPERTREE MONTESSORI
FACILITY NUMBER: 374845328
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2022
Section Cited
CCR
101212(c)
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The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.
The incident was not reported to the parents of the child.
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The Director has been reminded of the regulations for reporting incidents to parents.
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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.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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 STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2022 and conducted by Evaluator Andrea Taylor
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20221006165811

FACILITY NAME:PEPPERTREE MONTESSORIFACILITY NUMBER:
374845328
ADMINISTRATOR:HOWARD, KAYLAFACILITY TYPE:
850
ADDRESS:427 COLLEGE WAY, STE ITELEPHONE:
(760) 940-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:92CENSUS: 22DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:Cheryl Gillins - DirectorTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Qualifications - substitute staff did not have qualifications
INVESTIGATION FINDINGS:
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On the date and time listed, Licensing Program Analyst (LPA) Andrea Taylor arrived at the facility for the purpose of delivering the complaint finding regarding the investigation of the above-referenced allegation. On October 7, 2022, Community Care Licensing (CCL) received a complaint alleging that substitute staff was unqualified.
An initial 10-day visit was conducted on October 12, 2022. LPA conducted interviews with staff members, and LPA obtained pertinent documents/information regarding the investigation.
Based on the interrviews and review of records the substitute teachers have qualifications. There were some substitutes LPA was unable to review the files making their quaificaiton unknown.
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 allegation is UNSUBSTANTIATED.
In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.
Exit interview was conducted. Appeal Rights provided. Notice of site visit must be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 10-CC-20221006165811
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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: PEPPERTREE MONTESSORI
FACILITY NUMBER: 374845328
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2022
Section Cited
CCR
101223(a)(3)
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Personal Rights - To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: ...
This was not met as evidenced by:
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The Director will retrain the staff on Personal Rights and submit the agenda to LPA Taylor.




andrea.taylor@dss.ca.gov
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staff member picked child who was crying up, holding the child while walking with child across the room and sat child down in a chair.
This is an immediate risk to the health and safety of the 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.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 7