198019814-6-7-2021-33-CC-ACHO-C3SBCW-20210608005810

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019814
Report Date: 06/07/2021
Date Signed: 06/07/2021 04:43:05 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
04/01/2021 and conducted by Evaluator Jose Guzman

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20210401103823

FACILITY NAME:	PRIMANTI MONTESSORI ACADEMY		FACILITY NUMBER:	198019814
ADMINISTRATOR:	HISSANKA GUNASEKARA		FACILITY TYPE:	850
ADDRESS:	10947 VALLEY HOME AVE		TELEPHONE:	(562) 943-0246
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	124	CENSUS: 71	DATE:	06/07/2021
		UNANNOUNCED	TIME BEGAN:	02:03 PM
MET WITH:	Director, Maribeth Peralta		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Daycare child sustained unexplained injuries while in care

INVESTIGATION FINDINGS:

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On June 7, 2021 at 02:03 p.m., Licensing Program Analyst (LPA) Jose Guzman, contacted Director, Maribeth Peralta, via telephone due to COVID-19 and precautionary measures in order to provide the findings of the complaint investigation. At 02:05 p.m., the call was transferred into a FaceTime tele-inspection. LPA explained that the purpose of this inspection is to provide the Director with complaint findings. During this tele-inspection the Director took LPA on a virtual tour of the facility. There were 71 children observed to be present with 8 staff at the facility during this tele-inspection.
Personal Rights: Complainant alleged daycare child sustained unexplained injuries while in care. Complainant reported that Parent 1 (P1) stated that when Child 1 (C1) removed the long-sleeved shirt after daycare and had two bruises on the inner upper arm and a bruise by each elbow. LPA interviewed Staff 1 (S1) and Staff 2 (S2). S1 and S2 stated that the child did not complain of any injuries and no injuries to the child were reported by the staff. Both stated that the child had a long-sleeved shirt on the day of the alleged incident. LPA interviewed P1 and Witness 1 (W1), who stated that the day of the incident was picture day and C1 was wearing a short sleeve shirt. Page 1 of 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

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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Control Number 33-CC-20210401103823

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: PRIMANTI MONTESSORI ACADEMY	FACILITY NUMBER: 198019814
	VISIT DATE: 06/07/2021

NARRATIVE

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Pictures taken on that day, confirm that C1 wore a short sleeve shirt. On one of the images, C1 lifted the right arm and there is no visible bruise on the elbow. LPA attempted to interview C1 but C1 was not verbal or unwilling to speak. LPA interviewed Parent 2 (P2) and Parent 3 (P3) who stated that they are very satisfied with the teachers and staff at the day care. No other concerns were found from parents or staff. Police reports obtained by the LPA from the Whittier Police Department did not disclose additional information to prove the allegations as no statement was obtained from C1 and therefore concluding that “At this time, no crime is suspected…”
Due to conflicting information obtained during the course of the investigation through interviews and record reviews the evidence does not support, nor disprove the above allegation that the day care child sustained unexplained injuries while in care. Therefore, the allegation has been determined to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit FaceTime interview has been conducted with Director, Maribeth Peralta. Appeal Rights were verbally explained to the Director. A copy of this report has been signed by LPA Jose Guzman. This report along with the Appeal Rights will be e-mail to the Director, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. The Director agrees to sign the bottom of each page of the LIC 9099 and return the originals to LPA Jose Guzman in-person or via U.S. Mail. A Notice of Site Visit was not provided to Director since a physical inspection was not conducted.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

LIC9099 (FAS) - (06/04)

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