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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422412
Report Date: 11/18/2022
Date Signed: 11/18/2022 12:47:37 PM

Document Has Been Signed on 11/18/2022 12:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LEARN AND PLAY MONTESSORI MAPLE, INC.FACILITY NUMBER:
013422412
ADMINISTRATOR:CHAPPELLE, AMYFACILITY TYPE:
850
ADDRESS:37220 MAPLE ST.TELEPHONE:
(510) 713-2402
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 74TOTAL ENROLLED CHILDREN: 74CENSUS: 34DATE:
11/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rahhika Dogra, Edith Vasquez and Natasha AguilarTIME COMPLETED:
11:00 AM
NARRATIVE
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On November 18, 2022 at approximately 9:30am Licensing Program Analyst (LPA) R. Haderer arrived unannounced for a case management visit to review an unusual incident that happened on October 25, 2022 and was phoned into the licensing office on November 3, 2022 and also filed on an LIC624 form the same day.

LPA met with center director Radhika Dogra, curriculum director Edith Vasquez and Natasha Aguilar. On arrival there were 34 children in care and 10 fingerprint cleared and associated teachers, and 1 administrative staff. The center is in ratio today.

LPA reviewed the incident which led to the dismissal of the former Center Director (CD1). LPA, site director and curriculum director toured the facility to review the location where the incident took place.

The incident happened in room 5 on October 25, 2022 at approximately 12:30pm. The child (C1) is 3 years, 3 months old that has a developmental speech delay and is unable to effectively communicate. He was crying all morning on October 25, 2022 as heard by the curriculum director and around 12:30 the crying stopped.

Curriculum Director left her office (which is adjacent to classroom 5) and walked past the door and thought she saw the former center director (CD1) with her leg on top of the child. She went to the end of the hall and looked back into the room again and did see the director with her leg on the child. She asked the teacher in the room (T1) if everything was okay. T1 told her that the director always puts her leg on the child to hold him down and her elbow on his neck and the child then falls asleep quickly. The curriculum teacher opened an investigation and saw the center director in a video with her leg on the child. The director was sent home on administrative leave with pay until an investigation could be carried out.

Continued on page 2................
Chandra Charles
Russell Haderer
DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEARN AND PLAY MONTESSORI MAPLE, INC.
FACILITY NUMBER: 013422412
VISIT DATE: 11/18/2022
NARRATIVE
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An internal investigation was done, there were meetings with staff, HR and the COO. As a result, the center director was terminated effective 11/02/2022. There was a delay of more than one week in reporting the incident to licensing. See LIC809D for deficiency.

LPA instructed senior staff to view a video on the CCLD website regarding procedure on reporting unusual incident reports and also the staff will view the video on personal rights of children.

Child Care Reporting Requirements:

https://ccld.childcarevideos.org/child-care-center-operators/child-care-reporting-requirements/

Children’s Personal rights in Childcare:

https://ccld.childcarevideos.org/child-care-center-operators/childrens-personal-rights-in-child-care/


The child's parents subsequently withdrew the child from care on November 10, 2022.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the site director Radhika Dogra and curriculum director Edith Vasquez.

SUPERVISOR'S NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/18/2022 12:47 PM - It Cannot Be Edited


Created By: Russell Haderer On 11/18/2022 at 11:31 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LEARN AND PLAY MONTESSORI MAPLE, INC.
FACILITY NUMBER: 013422412

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2022
Section Cited

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101212 Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center...a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted
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to the Department within seven days following the occurrence of such event.
(1)(C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement was not met, the report was made 9 days later, and therefore posed a potential risk to child in care
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Type B
11/28/2022
Section Cited

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101223 Personal Rights
(a)(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living .....
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Based on observation and interview, the licensee did not meet the requirement of maintaining personal rights of a child which poses a potential Health and 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.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022


LIC809 (FAS) - (06/04)
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