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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198019318
Report Date: 10/28/2021
Date Signed: 10/28/2021 04:41:54 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/19/2021 and conducted by Evaluator Cynthia Reyes
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20210719084807
FACILITY NAME:MONTESSORI ACADEMY OF ARCADIAFACILITY NUMBER:
198019318
ADMINISTRATOR:EMILENE JULEFACILITY TYPE:
830
ADDRESS:940 W DUARTE ROADTELEPHONE:
(626) 447-2246
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY:28CENSUS: 17DATE:
10/28/2021
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jasmin VejarTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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On 10/28/2021 at 8:45 AM, Licensing Program Analyst (LPA) Cynthia Reyes, conducted an unannounced Complaint Inspection to conclude the investigation regarding the above complaint allegation. LPA met with Jasmin Vejar, Teacher who took LPA on a tour of the facility. Census of children were taken, staff names and positions were documented. Due to COVID- 19 precautionary measures were taken during the entire inspection and all individuals present during this inspection wore appropriate personal protective equipment. Around 9:15 AM Suzy Karas arrived and identified herself as the Administrator. Director Emilene Jule arrived about 9:35 AM.

During the investigation, interviews were conducted with witnesses including detectives, medical records and other documentation were obtained, and video footage was reviewed. This agency has investigated the complaint alleging Child #1 received injury while under the care of the facility. The alleged incident involving Child #1 allegedly occurred at the facility on 7/15/2021. On 7/17/2021, Child #1 was transported to the hospital by Child #1’s authorized representatives and was evaluated for “non displaced obliquely oriented fracture to the left humerus (spiral fracture).” Continued on page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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 33-CC-20210719084807
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI ACADEMY OF ARCADIA
FACILITY NUMBER: 198019318
VISIT DATE: 10/28/2021
NARRATIVE
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Page 2

Based on evidence and observations, this agency has determined the facility is not responsible for Child #1's non-displaced obliquely oriented fracture to the left humerus (spiral fracture). 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 at the facility, therefore the allegation is unsubstantiated.

Per California Code of Regulations Title 22, Division 12, no deficiency cited. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Emilene Jule.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2