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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004260
Report Date: 11/29/2023
Date Signed: 11/29/2023 01:55:36 PM

Unsubstantiated


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
09/20/2023 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230920140455
FACILITY NAME:EDISON MONTESSORI SCHOOLFACILITY NUMBER:
414004260
ADMINISTRATOR:ANGELA TANGFACILITY TYPE:
850
ADDRESS:303 TWIN DOLPHIN DRIVE, # 104TELEPHONE:
(650) 593-6824
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94065
CAPACITY:45CENSUS: 31DATE:
11/29/2023
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Angela TangTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff handled day care child in a rough manner.
INVESTIGATION FINDINGS:
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On 11/29/2023 at 10:55AM., Licensing Program Analyst (LPA) Luis J. Gomez met with Director, Angela Tang. Purpose of the inspection was explained and was for an Unannounced, Complaint Investigation. Present was the Director and 3 staff supervising for 31 children. Children present had been signed in. LPA inspected facility indoors and outdoors for health and safety hazards.

During today's inspection, LPA performed site observations, interviews, and reviewed facility records. LPA reminded director to ensure children's immunization records are stored in facility files. Advisory Note: Technical Violation (LIC9102TV) was issued.

During the course of the investigation observations were conducted on 9/28/2023 and 11/29/2023. A review of the facility records was complete, which included the Staff Records, Children Records, and Parent Handbook. LPA conducted interviews with the Director, Staff, and Children. (REFER TO LIC9099C, FOR CONT.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
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 2
Control Number 05-CC-20230920140455
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: EDISON MONTESSORI SCHOOL
FACILITY NUMBER: 414004260
VISIT DATE: 11/29/2023
NARRATIVE
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(Page 2)
Regarding allegation of staff handled day care child in a rough manner; Based on information collected, LPA was unable to determine if the allegation made is valid. During interviews, staff reported using appropriate intervention when assisting day-care children.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.



Exit interview was conducted with Director, Angela Tang. Complaint Report was explained and Appeal Rights were given. Notice of Site Visit was posted during inspection.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2