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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444417076
Report Date: 08/31/2023
Date Signed: 08/31/2023 12:37:46 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, 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
08/24/2023 and conducted by Evaluator Cortney Nelson
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230824173104
FACILITY NAME:MONTESSORI COMMUNITY SCHOOLFACILITY NUMBER:
444417076
ADMINISTRATOR:MADELYNN VAN DEN HEUVELFACILITY TYPE:
850
ADDRESS:123 SOUTH NAVARRA DRIVETELEPHONE:
(831) 439-9625
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY:90CENSUS: 30DATE:
08/31/2023
UNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Madelynn Van Den HeuvelTIME COMPLETED:
12:47 PM
ALLEGATION(S):
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Lack of supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Madelynn Van Den Heuvel, and explained purpose of today's visit, conduct observations of classrooms (Dolphins & Otters) and deliver complaint investigation findings. LPA was admitted into the facility by the Site Director upon arrival.

LPA observed both classrooms for approximately two hours and observed children are using the restroom without staff supervision. The bathroom has nooks, which prohibits staff from visually supervising and assisting children in the bathroom from outside of it. Staff are responsible for visually supervising children at all times. Based on the available evidence, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.

California Code of Regulations (Title 22, Division 12) are being cited on attached LIC9099-D.

***Report continues on LIC9099-C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
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 3
Control Number 07-CC-20230824173104
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MONTESSORI COMMUNITY SCHOOL
FACILITY NUMBER: 444417076
VISIT DATE: 08/31/2023
NARRATIVE
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** Continued from LIC9099**

LPA informed Site Director, Madelynn Van Den Heuvel, that this report dated 8/31/2023 documents one Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the Licensee to provide a copy of this licensing report dated (8/31/2023) that documents one Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

As a result of today's inspection, a deficiency has been cited, see LIC9099-D.

Exit interview conducted and report was reviewed with the Site Director, Madelynn Van Den Heuvel.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20230824173104
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MONTESSORI COMMUNITY SCHOOL
FACILITY NUMBER: 444417076
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/01/2023
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.

This requirement was not met as evidenced by:
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Site Director to develop a plan of correction and submit to the Department by 9/1/2023, outlining how children will be visually supervised while using the restroom.
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During observation conducted by LPA Nelson, multiple children were observed to be using restroom without staff supervision, which poses an immediate risk to the health, safety, and personal rights of 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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3