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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013412619
Report Date: 02/20/2024
Date Signed: 02/20/2024 03:24:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 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
02/12/2024 and conducted by Evaluator Jaleesa Jackson
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240212172632
FACILITY NAME:MONTESSORI CHILDREN'S CENTERFACILITY NUMBER:
013412619
ADMINISTRATOR:SALVADOR, LULETTEFACILITY TYPE:
830
ADDRESS:33170 LAKE MEAD DRIVETELEPHONE:
(510) 489-7510
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:20CENSUS: 9DATE:
02/20/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Lulette SalvadorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Staff covered infant's face with blanket.
Staff did not provide appropriate sleeping accommodations for infant in care.
INVESTIGATION FINDINGS:
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On 02/20/2024, Licensing Program Analyst (LPA) Jaleesa Jackson met with Director Lulette Salvador for a complant that was received filed against Montessori Children's Center regarding the above allegations. Present during the inspection was 4 staff and 9 infants. LPA inspected both infant classrooms (Lenido and Willow) during today's visit. LPA Jackson conducted interviews and file reviews.

The allegation the facility had an infants head covered with a blanket has been SUBSTANTIATED. The allegation the staff did not provide appropriate sleeping accomodations has been SUBSTANTIATED. Based on LPA's interviews and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Title 22 regulations are being cited on the attached LIC 9099D. LIC 9224 was issued and discussed.

A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed. An exit interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
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 2
Control Number 52-CC-20240212172632
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI CHILDREN'S CENTER
FACILITY NUMBER: 013412619
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2024
Section Cited
CCR
101430(a)(3)(D)
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101430(a)(3)(D) Notwithstanding Section 101230, the following shall apply: An infant's head shall not be covered while sleeping.
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Director is to immediately have an all staff meeting regarding safe sleep for infants. The agenda will include the following. Reviewing all safe CCLD safe sleep regulations. Reviewing the safe sleep video on https://safetosleep.nichd.nih.gov/resources/videos.
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This requirement was not met as evidenced by:
Based on interviews and record review, a blanket was placed on an infants head which posed an immediate risk to the health and safety of children in care.
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Director will submit to LPA by email:
The agenda, sign in sheet of all staff present, and statements from all staff about how they will stay in compliance with the safe sleep regulations.
Type A
02/21/2024
Section Cited
CCR
101430(a)(3)(E)
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101430(a)(3)(E) Notwithstanding Section 101230, the following shall apply: If an infant falls asleep before being placed in a crib, staff shall move the infant to a crib as soon as possible.
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Director is to immediately have an all staff meeting regarding safe sleep for infants. The agenda will include the following. Reviewing all safe CCLD safe sleep regulations. Reviewing the safe sleep video on https://safetosleep.nichd.nih.gov/resources/videos.
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This requirement was not met as evidenced by:
Based on interviews and record review, staff did not immediate move a sleeping infant from feeding chair which posed an immediate risk to the health and safety of children in care.
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Director will submit to LPA by email:
The agenda, sign in sheet of all staff present, and statements from all staff about how they will stay in compliance with the safe sleep regulations.
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: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2