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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004588
Report Date: 11/20/2024
Date Signed: 11/20/2024 02:48:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2024 and conducted by Evaluator Zeynep Basak
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20241113155328
FACILITY NAME:MISSION MONTESSORI (INF)FACILITY NUMBER:
384004588
ADMINISTRATOR:DOMINGO, ROCHELLEFACILITY TYPE:
830
ADDRESS:50 FELL STREETTELEPHONE:
(415) 805-8315
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:54CENSUS: 36DATE:
11/20/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Dr. LaRhonda MartinTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility did not post notice of Type A citation for required 30 days.
INVESTIGATION FINDINGS:
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On 11/20/2024 Licensing Program Analyst, (LPA) Zeynep Basak conducted an unannounced visit to open the complaint and met with the executive director, Dr LaRhonda Martin. The purpose of the inspection was explained upon entry.
LPA observed 7 staff, 17 infants, and 19 toddlers present during today's visit.

LPA observed the Notice of Site Visit for Type A violation which was cited on 10/25/2024 not posted in the facility. LPA discussed it with the director and the director found it and posted it during the LPA visit.

Based on the LPA observation and discussion with the director the above allegation is found to be substantiated and the complaint to be closed.

A Type B violation will be issued in accordance with Title 22, Division 6 Health and Safety Code Chapter 3.4 California Child Day Care Act Article 02. Administration of Child Day Care Licensing 1596.8595(a)(1) and Civil Penalty will be assessed today.

A copy of this report was reviewed, signed, and given to the director, Dr. LaRhonda Martin, and findings were delivered.
An exit interview was conducted, and the Notice of Site Visit was provided to be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
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 2
Control Number 05-CC-20241113155328
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MISSION MONTESSORI (INF)
FACILITY NUMBER: 384004588
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2024
Section Cited
HSC
1596.8595(a)(1)
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1596.8595(a)(1)The licensing report provided by the department shall be posted immediately upon receipt, adjacent to the postings required pursuant to Section 1596.817 and on, or immediately adjacent to, the interior side of the main door to the facility and shall remain posted for 30 consecutive days.

This requirement is not met by:
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The director will be posted immediately.
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Based on LPA observation and interview with the director, the facility did not comply with the section cited above which poses a potential health, safety, or personal rights risk to person 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: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
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