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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198020471
Report Date: 10/12/2022
Date Signed: 10/14/2022 03:38:57 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, 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
09/28/2022 and conducted by Evaluator Carolyn Tuba
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20220928161903
FACILITY NAME:ACACIA MONTESSORI SCHOOL COVINA INC.FACILITY NUMBER:
198020471
ADMINISTRATOR:MILDRED BAUTISTAFACILITY TYPE:
850
ADDRESS:450 W ROWLAND STTELEPHONE:
(626) 966-9356
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY:60CENSUS: 20DATE:
10/12/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Mildred BautistaTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility is not allowing parent to review the child’s records on file
INVESTIGATION FINDINGS:
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On October 12, 2022, at 3:30 pm, Licensing Program Analyst (LPA) Carolyn Tuba conducted a complaint investigation to deliver findings at the above facility. A COVID-19 risk assessment was conducted prior to entering. LPA met with Director, Mildred Bautista who guided LPA on a tour of the facility. There was a total of 20 children present with 3 staff.

During this investigation, LPA interviewed the Reporting Party, Director and Parent #1 (P1). According to the director she confirmed that the parent was not given rights to the child’s file. Director also confirmed that there was no legal documentation on file stating otherwise.

Based on interviews conducted and records reviewed, the allegation of “Facility is not allowing parent to review the child’s records on file” is substantiated meaning that the preponderance of evidence standard has been met. The facility is being cited a Type B deficiency, please see LIC9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
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 33-CC-20220928161903
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: ACACIA MONTESSORI SCHOOL COVINA INC.
FACILITY NUMBER: 198020471
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/12/2022
Section Cited
CCR
101218.1(b)(3)
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Admission Procedures and Parental and Authorized Representative's Rights (b) At the time of acceptance of each child in care, the licensee shall
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Per Director she understands of parent rights and after LPA consulatation understands that unless there is legal documents
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inform each child's parent or authorized representative of his/her rights that include, but are not limited to, the following:
(3)To review the child care center’s public file kept by the local licensing office in accordance with Health and Safety Code Section 1596.859.
This requirement was not met as evidenced by:

Based on interview with Director.


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stating otherwise, that a parent has rights to view their child's file.
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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: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 33-CC-20220928161903
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: ACACIA MONTESSORI SCHOOL COVINA INC.
FACILITY NUMBER: 198020471
VISIT DATE: 10/12/2022
NARRATIVE
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LPA provided consultation to Director on parents’ rights for a child development center.

An exit interview was conducted, and a copy of this report was provided, along with Notice of Site Visit and Appeal Rights to the Director, Mildred Bautista.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3