444408893-9-12-2024-07-CC-BDEL-DB7AF4-20241119231030

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 444408893
Report Date: 09/12/2024
Date Signed: 09/12/2024 12:22:30 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/16/2024 and conducted by Evaluator Mandeep Kaur

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20240716082539

FACILITY NAME:	QUAIL HOLLOW MONTESSORI		FACILITY NUMBER:	444408893
ADMINISTRATOR:	CHERYL MCGOWEN		FACILITY TYPE:	850
ADDRESS:	187 LAUREL DRIVE		TELEPHONE:	(831) 335-4710
CITY:	FELTON	STATE: CA	ZIP CODE:	95018
CAPACITY:	42	CENSUS: 27	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Melinda Gillen		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Mandeep Kaur conducted an unannounced follow up complaint investigation. LPA met with owner, Melinda Gillen and explained Purpose of today's investigation: deliver investigation findings. During the course of the investigation, LPA conducted physical plant inspections, reviewed facility records & documents and conducted staff & parents interviews.

Based on interviews, record reviews, and evidence gathered during the investigation process, the Department concludes that the Facility was in disrepair in Sandpiper room and Pelicans room where sinks and toilets were clogged up. Owner self-admitted that the issue might have started from Sandpiper classroom where a toilet was overflowing with water, about a few months ago. The allegation noted above is thus found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

A Type B deficiency is being cited on the attached LIC 9099D form. Appeal rights given and exit interview conducted with owner, Melinda Gillen.

NOTICE OF SITE VISIT ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/16/2024 and conducted by Evaluator Mandeep Kaur

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20240716082539

FACILITY NAME:	QUAIL HOLLOW MONTESSORI		FACILITY NUMBER:	444408893
ADMINISTRATOR:	CHERYL MCGOWEN		FACILITY TYPE:	850
ADDRESS:	187 LAUREL DRIVE		TELEPHONE:	(831) 335-4710
CITY:	FELTON	STATE: CA	ZIP CODE:	95018
CAPACITY:	42	CENSUS:	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Melinda Gillen		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

1
2
3
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5
6
7
8
9

Facility staff does not ensure day care children from having access to hazardous materials while in care.

INVESTIGATION FINDINGS:

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7
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13

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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 07-CC-20240716082539

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: QUAIL HOLLOW MONTESSORI	FACILITY NUMBER: 444408893
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/12/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/19/2024 Section Cited CCR 101238(a)	1 2 3 4 5 6 7	Buildings and Grounds: (a)The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Owner has agreed to submit the written statement about what process will be put in place to fix the disrepair in the facility and to avoid the future clogs in toilets and sinks by POC due date.
	8 9 10 11 12 13 14	Based on interviews, record reviews, and evidence gathered during the investigation process, the Department concludes that the Facility was in disrepair in Sandpiper room and in Pelicans room.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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