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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334844579
Report Date: 10/28/2021
Date Signed: 10/28/2021 01:13:58 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2021 and conducted by Evaluator Destinee Hogue
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20211022094141
FACILITY NAME:MONTY'S MONTESSORI ACADEMY OF CALIMESAFACILITY NUMBER:
334844579
ADMINISTRATOR:GARCIA, MONIQUEFACILITY TYPE:
850
ADDRESS:9580 CALIMESA BLVDTELEPHONE:
(909) 795-2472
CITY:CALIMESASTATE: CAZIP CODE:
92320
CAPACITY:54CENSUS: 0DATE:
10/28/2021
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Licensee, Lisa GilfillanTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Record Keeping-Staff do not have health screenings
INVESTIGATION FINDINGS:
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On 10/28/2021 at 09:09am, Licensing Program Analyst (LPA) Destinee Hogue conducted an inspection regarding a complaint received. LPA Hogue met with Licensee, Lisa Gilfillan and informed her about the allegations and purpose of today’s inspection. LPA toured the facility, took census, and reviewed/gathered facility information. There were no children and staff present at the time of this inspection.

It is reported that facility staff do not have proper health screening (LIC503) and staff members are present and working in the Garden and Solar classrooms. On 10/28/2021, LPA Hogue reviewed facility records and there are staff members working at the facility who do not have a completed LIC503-Health Screening on file. Staff members have been working at the facility since 2019 and 2020. Based on records review, the department has determined the preponderance of evidence standard has been met and the above allegation is found to be SUBSTANTIATED.
See LIC809D for cited deficiencies. LPA Hogue conducted an exit interview and provided a copy of this report to Licensee, Lisa Gilfillan. A NOTICE OF SITE VISIT WAS ISSUED and appeal rights provided.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
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 3
Control Number 09-CC-20211022094141
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MONTY'S MONTESSORI ACADEMY OF CALIMESA
FACILITY NUMBER: 334844579
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2021
Section Cited
CCR
101217(a)(11)
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Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 101216(g).

This requirement was not met as evidenced by:
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Licensee agrees to submit a completed LIC503-Health Screening for Staff #2 and Staff #4 by 11/29/2021. Proof of completed LIC503 can be submitted via email or mail.
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Based on review of facility records, the Licensee did not comply with the section above and did not have proof of completed LIC503-Health Screening for Staff #2 and Staff #4. This poses a potential health, safety, and personal rights risk to children in care.
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During this inspection, Title 22 Regulation-Personnel Requirements: 101216(g) was provided to Licensee, Lisa Gilfillan.
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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: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:

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

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