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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434410825
Report Date: 10/15/2024
Date Signed: 10/17/2024 10:09:52 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/08/2024 and conducted by Evaluator Anna Morales
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20241008151129
FACILITY NAME:EMPIRE MONTESSORI PRESCHOOLFACILITY NUMBER:
434410825
ADMINISTRATOR:CAROLINA DINOFACILITY TYPE:
850
ADDRESS:499 NORTH 11TH STREETTELEPHONE:
(408) 295-5900
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY:56CENSUS: 28DATE:
10/15/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marniee SwansonTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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1. Staff not meeting children's toileting needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Anna Morales conducted an initial Complaint investigation for the above allegation. LPA was greeted by Site Director Marniee Swanson and discussed the allegation.

LPA toured the classrooms and observed in Classroom #1, there were 18 children with three staff, and in Classroom #2 , there were 10 children with one staff.

(continue on LIC9099c)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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 3
Control Number 07-CC-20241008151129
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: EMPIRE MONTESSORI PRESCHOOL
FACILITY NUMBER: 434410825
VISIT DATE: 10/15/2024
NARRATIVE
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Based on the interviews conducted, a verbal agreement was made (approximately in the beginning of September 2024), between the facility and with one of the Parent's (P1) regarding one of the Children's(C1) Toileting needs. On 9/20/24, the verbal agreement was not followed and C1's toileting needs were not met.

Based on interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on the next page. Licensee/Director was informed that failure to correct the deficiencies may result in civil penalties.

Exit Interview was conducted with Director Marniee Swanson. Appeal Rights were given

Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20241008151129
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: EMPIRE MONTESSORI PRESCHOOL
FACILITY NUMBER: 434410825
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/29/2024
Section Cited
CCR
101223(a)(2)
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101223:Personal Rights(a)(2):(a) The licensee shall ensure that each child is accorded the following personal rights:
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Director stated that she will submit a plan to ensure that the children's toilet's needs are being met and submit by the POC date.
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(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by: Based on the interviews conducted, a verbal agreement was made between the facility and with (P1) regarding (C1) Toileting needs which was not followed on 9/20/24. This poses a potential health and safety risk to children in care.
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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: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3