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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364830892
Report Date: 05/22/2024
Date Signed: 05/22/2024 12:49:20 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 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
04/30/2024 and conducted by Evaluator Rachel Zeron
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20240430141529
FACILITY NAME:MONTESSORI ACADEMY OF CHINOFACILITY NUMBER:
364830892
ADMINISTRATOR:ARIANA RAMOSFACILITY TYPE:
850
ADDRESS:4511 RIVERSIDE DRIVETELEPHONE:
(909) 591-3937
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:60CENSUS: 24DATE:
05/22/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Thushara DeSilvaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff do not keep the outdoor area free from hazard materials
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Rachel Zeron and Blanca Ruiz arrived at the facility to conduct a visit regarding a complaint received by the regional office on 04/30/2024, a subsequent visit was conducted on 05/09/2024. LPA Zeron toured the facility and took a census. LPAs met with Thushara DeSilva to further discuss the complaint/allegations. On today's visit, findings were delivered.


LPA Zeron and LPA Ruiz investigated the above allegation and gathered the following information regarding the issue: Staff do not keep the outdoor area free from hazard materials. Based on interviews conducted, dangerous items were found by children in care on the playground on multiple occasions. Items included, broken glass, remains of a rodent, and smoking devices. The facility is located in a busy intersection, next to multiple liquor/convenient stores, and an apartment complex is located directly behind the facility, which plays a factor. Interviews revealed that the facility's playground is not being inspected by staff upon arrival, prior to the children's playground time.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
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 5
Control Number 09-CC-20240430141529
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MONTESSORI ACADEMY OF CHINO
FACILITY NUMBER: 364830892
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/29/2024
Section Cited
CCR
101238.2(d)(2)
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The surface of the outdoor activity space shall be maintained: (2)Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.
This requirement was not met as evidenced by:
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Licensee agrees to come up with a plan for opening procedures which includes inspecting the inside and outside of the facilty prior to children's arrival. A roster and signature of the staff meeting which goes over the new opening procedures will be sent to LPA by POC date.
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Based on dangerous debris found on the children's playground that children found while playing. This poses a potential health, safety risk to children in care.
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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: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 09-CC-20240430141529
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MONTESSORI ACADEMY OF CHINO
FACILITY NUMBER: 364830892
VISIT DATE: 05/22/2024
NARRATIVE
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Based on LPA observations and interviews which were conducted and a review of additional pertinent information obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 12 is being cited on the attached LIC 9099D.

Exit interview was conducted with Thushara De Silva, Licensee. A copy of the report and Notice of Site Visit issued. Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5