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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004587
Report Date: 12/02/2024
Date Signed: 12/02/2024 02:44:09 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2024 and conducted by Evaluator Zeynep Basak
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20241115154237
FACILITY NAME:MISSION MONTESSORI (PS)FACILITY NUMBER:
384004587
ADMINISTRATOR:DR.LARHONDA MARTINFACILITY TYPE:
850
ADDRESS:50 FELL STREETTELEPHONE:
(415) 805-8315
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:120CENSUS: 43DATE:
12/02/2024
UNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Dr. LaRhonda MartinTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Type A violation cited in 09/26/2023 was not provided at enrollment.
INVESTIGATION FINDINGS:
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On December 2, 2024, Licensing Program Analyst, (LPA) Zeynep Basak conducted an unannounced visit to continue to complaint investigation and met with the executive director, Dr LaRhonda Martin. The purpose of the inspection was explained upon entry.

LPA observed 7 staff and 43 preschool children present during today's visit. LPA verified staff members’ fingerprint clearance on the Guardian website.

LPA reviewed the electronic enrollment records, and children's files, and interviewed with the director during the investigation.

Based on the LPA observation, record review, and discussion with the director the above allegation is found to be substantiated and the complaint to be closed.

A Type B violation will be issued in accordance with Health and Safety Code 1596.8595(c)(2) on the LIC9099D page.

A copy of this report was reviewed, signed, and given to the director, Dr. LaRhonda Martin, and findings were delivered.
An exit interview was conducted, and the Notice of Site Visit was provided to be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
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 2
Control Number 05-CC-20241115154237
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MISSION MONTESSORI (PS)
FACILITY NUMBER: 384004587
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2024
Section Cited
HSC
1596.8595(c)(2)
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1596.8595(c)(2)A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care(2)Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing report that the licensee has received during the prior 12-month period that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care.
This requirement is not met by:
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The director informed and provided a copy of the LIC9224 form to all parents for them to sign. The director will make sure she provides a LIC 9224 form to all and newly enrolling parents when they have a Type A violation.
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Based on record review, and interviews Type A citation information and document has not been provided during enrollment and the above allegation is found to be SUBSTANTIATED.
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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: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2