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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013412618
Report Date: 10/14/2022
Date Signed: 10/14/2022 12:34:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2022 and conducted by Evaluator Kelly Phan
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20220912104815
FACILITY NAME:MONTESSORI CHILDREN'S CENTERFACILITY NUMBER:
013412618
ADMINISTRATOR:KHAN, YASMINFACILITY TYPE:
850
ADDRESS:33170 LAKE MEAD DRIVETELEPHONE:
(510) 489-7510
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:110CENSUS: 42DATE:
10/14/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Yasmin KhanTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child left outside with no supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 14, 2022 approximately at 11:45AM, Licensing Program Analyst (LPA) Kelly Phan arrived and met with Center Director Yasmin Khan to deliver findings for the allegation stated above. Present during today's inspection was 42 preschool aged children, 5 toddlers, and 10 infants along with 10 fingerprinted and associated staff members.

During the course of the investigation, interviews, observations, and children files were conducted. It was alleged that a child was left unattended at the facility. 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 conducted and report was reviewed with center director, Yasmin Khan.
Appeal rights and notice of site visit was given and must be posted for 30 days.


Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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