073405005-6-27-2019-02-CC-ARON-BFQSJE-20190905135455

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073405005
Report Date: 06/27/2019
Date Signed: 06/27/2019 04:44:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2019 and conducted by Evaluator Geneen Redmond

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20190506141751

FACILITY NAME:	A LITTLE WORLD MONTESSORI ACADEMY		FACILITY NUMBER:	073405005
ADMINISTRATOR:	SAMUDRA DE ALWIS		FACILITY TYPE:	850
ADDRESS:	355 PARKER AVE		TELEPHONE:	(510) 799-6361
CITY:	RODEO	STATE: CA	ZIP CODE:	94572
CAPACITY:	34	CENSUS: 16	DATE:	06/27/2019
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	SAMUDRA DE ALWIS, DIRECTOR		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff operating out of ratio - Neglect/Lack of Supervision

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Redmond, conduted an unannounced, Complaint Investigation visit on this date. LPA met with Samudra De Alwis, Director. LPA observed a second teacher, present on this date. Currently, children are taking a nap.

LPA requested and reviewed facility documentation including student sign in sheets and teacher time sheets. LPA also conducted interviews of staff. Based on the information LPA obtained during the course of investigation, LPA is unable to make a determination as to whether or not the facility has operated out of ratio. Therefore, this allegation is - UNSUBSTANTIATED.

A finding of "Unsubstantiated" means, that the allegation may or may have occurred, however, there is not a preponderance of evidence to substantiate the allegation. If information is received in the future that may change the outcome of the investigation. Community Care Licensing reserves the right to reopen the complaint.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2019 and conducted by Evaluator Geneen Redmond

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20190506141751

FACILITY NAME:	A LITTLE WORLD MONTESSORI ACADEMY		FACILITY NUMBER:	073405005
ADMINISTRATOR:	SAMUDRA DE ALWIS		FACILITY TYPE:	850
ADDRESS:	355 PARKER AVE		TELEPHONE:	(510) 799-6361
CITY:	RODEO	STATE: CA	ZIP CODE:	94572
CAPACITY:	34	CENSUS: 16	DATE:	06/27/2019
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	SAMUDRA DE ALWIS, DIRECTOR		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff used an inappropriate form of punishment - Personal Rights

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Redmond, conducted an unannounced, Complaint Investigation, regarding the above listed allegations on this date.

LPA conducted interviews of parents, children and staff on previous visits on 05/10/19 and 05/22/2019 regarding allegations. LPA is unable to ascertain whether children are "punished" outside of being removed from activities or being placed on "thinking" time, similar to a time out. Therefore, the allegation is UNSUBSTANTIATED.

A finding of "Unsubstantiated" means, that the allegation may or may have occurred, however, there is not a preponderance of evidence to substantiate the allegation. If information is received in the future that may change the outcome of the investigation. Community Care Licensing reserves the right to reopen the complaint.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 2