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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004260
Report Date: 01/10/2024
Date Signed: 01/10/2024 12:06:29 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
10/24/2023 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20231024103623
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: 32DATE:
01/10/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Angela TangTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff member handled daycare child in a rough manner.
INVESTIGATION FINDINGS:
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On 1/10/2024 at 8:50AM., Licensing Program Analyst, (LPA) Luis Gomez met with Director, Angela Tang. Purpose of inspection was explained and was for an unannounced complaint inspection. Present is facility were 5 staff supervising 32 children. Children present had been signed in. LPA inspected facility for health and safety hazards.

During inspection, LPA performed interviews, record review and observations.
At 11:00AM., Based on interviews, LPA confirmed facility director failed to report an unusual incident to the Department. Advisory Note: Technical Violation (LIC9102TV) was issued.

During the course of this investigation, observations were conducted on 11/2/2023 and 1/10/2024. A review of facility records was complete, which included the Children’s File, Staff Files, and Program Handbook. Interviews were conducted with Executive Director, Staff, and Children. (REFER TO LIC9099c, FOR CONT.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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 5
Control Number 05-CC-20231024103623
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: 01/10/2024
NARRATIVE
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(Page 2)
Regarding the allegation of staff member handled daycare child in a rough manner; Based on information obtained, LPA determine allegation made is valid. During investigation, it was reported staff used an inappropriate form of intervention while assisting daycare child.

Based on information obtained, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California code of Regulations (Title 22, Section 12 Chapter 1) is being cited on attached 9099D. Director was provided their appeal rights.

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov. This report and rights to comment and appeal rights were discussed.

The notice of site visit was provided to director.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 05-CC-20231024103623
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/19/2024
Section Cited
CCR
101223(a)(3)
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101223(a)(3) Personal Rights: (3) 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: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by:
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Director and staff will watch departments videos reviewing children's personal rights by due date: 1/19/2024.
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Based on information obtained, LPA determine allegation of staff handled child in rough manner is valid. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the department via email.
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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: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
10/24/2023 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20231024103623

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: 32DATE:
01/10/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Angela TangTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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9
Staff withheld food from children as a form of discipline.
Staff member yells at daycare children.
INVESTIGATION FINDINGS:
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On 1/10/2024 at 8:50AM., Licensing Program Analyst, (LPA) Luis Gomez met with Director, Angela Tang. Purpose of inspection was explained and was for an unannounced complaint inspection. Present is facility were 5 staff supervising 32 children. Children present had been signed in. LPA inspected facility for health and safety hazards.

During inspection, LPA performed interviews, record review and observations.
At 11:00AM., Based on interviews, LPA confirmed facility director failed to report an unusual incident to the Department. Advisory Note: Technical Violation (LIC9102TV) was issued.

During the course of this investigation, observations were conducted on 11/2/2023 and 1/10/2024. A review of facility records was complete, which included the Children’s File, Staff Files, and Program Handbook. Interviews were conducted with Executive 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: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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 5
Control Number 05-CC-20231024103623
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: 01/10/2024
NARRATIVE
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(Page 2)
Regarding the allegations of staff member yells at daycare children and withheld food from children as form of discipline; Based on evidenced collected, LPA was unable to determine if allegation are valid.

Although the allegation(s) 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. Copy of this report was provided to director.

The notice of site visit was provided to director.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5