198011974-2-11-2021-54-CC-KCHS-BYRQSJ-20210303112537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198011974
Report Date: 02/11/2021
Date Signed: 02/11/2021 04:41:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/02/2020 and conducted by Evaluator Raul Navarro

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20201002125024

FACILITY NAME:	MONTESSORI ON ELM PRESCHOOL + KINDERGARTEN		FACILITY NUMBER:	198011974
ADMINISTRATOR:	WIJEYEWICKREMA, CASSANDRA		FACILITY TYPE:	830
ADDRESS:	930 ELM AVENUE		TELEPHONE:	(562) 570-8080
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	24	CENSUS: 12	DATE:	02/11/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Cassandra Wijeyewickrema & Ayumi Rathnayaka		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility is operating out of ratio.
Facility is commingling day care children.
Day care children are not being provided a clean/sanitary environment.

INVESTIGATION FINDINGS:

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This complaint inspection was conducted by Licensing Program Analyst (LPA) Raul Navarro. Due to COVID-19 and precautionary measures, this inspection was conducted via teleconference to deliver the findings of the complaint investigation. The teleconference was conducted via FaceTime with Cassandra Wijeyewickrema & Ayumi Rathnayaka. There was a total of 12 children and 3 staff present during the inspection.

During the course of the investigation LPA Navarro conducted interviews with the reporting party, director, children, and parents. Per reporting party, facility is operating out of ratio, commingling the day care children, and day care children are not being provided a clean/sanitary environment. LPA interviewed the Director who deny the allegations. LPA interviewed staff, parents, and children. No corroborating statements were made.

*Report continues on the next page*

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

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 54-CC-20201002125024

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI ON ELM PRESCHOOL + KINDERGARTEN	FACILITY NUMBER: 198011974
	VISIT DATE: 02/11/2021

NARRATIVE

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Based on the interviews conducted and documentation obtained it has been determined that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove if the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated.

Exit interview was conducted via teleconference with Licensee Cassandra Wijeyewickrema & Director Ayumi Rathnayaka, during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to the Licensee via email with a read receipt to confirm receipt of the report and appeal rights.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

LIC9099 (FAS) - (06/04)

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