073408869-10-14-2021-02-CC-MMEA-C7XPYW-20211019114433

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073408869
Report Date: 10/14/2021
Date Signed: 10/14/2021 04:27:28 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
08/05/2021 and conducted by Evaluator Caroline Colson

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20210805122851

FACILITY NAME:	KEYSTONE MONTESSORI SCHOOL		FACILITY NUMBER:	073408869
ADMINISTRATOR:	PATHAK, ROHINI		FACILITY TYPE:	850
ADDRESS:	6639 BLAKE STREET		TELEPHONE:	(510) 709-5853
CITY:	EL CERRITO	STATE: CA	ZIP CODE:	94530
CAPACITY:	57	CENSUS: 43	DATE:	10/14/2021
		UNANNOUNCED	TIME BEGAN:	01:51 PM
MET WITH:	Rohini Pathak		TIME COMPLETED:	04:41 PM

ALLEGATION(S):

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Personal Rights - Staff behavior is aggressive towards children

INVESTIGATION FINDINGS:

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Licensing Program Analyst Caroline Colson met with Rohini Pathak, Center Director, for an unannounced complaint investigation. There are 43 children including 10 toddlers present. There are 12 staff members including the director. Interviews were conducted. Interviews revealed that a staff member embarassed a child on one specific occassion. A child had an accident at the facility and parent was called to pick the child up from school. The child's clothes wasn't changed prior to the parent picking up the child. Based on LPA's interviews which were conducted and a record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, 101223(a)(3) is being cited on the attached LIC 9099 D.

The attached type B deficiency is being cited today and must be corrected by the due date. An exit interview was conducted. Appeal rights were given and discussed. This report must be available for public review for 3 years.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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 02-CC-20210805122851

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: KEYSTONE MONTESSORI SCHOOL	FACILITY NUMBER: 073408869
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/14/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/28/2021 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	Personal Rights 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 including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.	1 2 3 4 5 6 7	Licensee will submit a plan by POC Due Date. Licensee will ensure that when a child has an accident that they will change the child's clothes and remind parents to always bring additional clothes to school.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by document review and licensee interview. There was an incident when a child had an accident and the child's clothes wasn't changed. Parent was called to pick up child from the facility. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
	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.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC9099 (FAS) - (06/04)

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