198015149-3-9-2022-33-CC-CGAN-CCXNUB-20220328104604

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198015149
Report Date: 03/09/2022
Date Signed: 03/09/2022 02:02:41 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/02/2022 and conducted by Evaluator Anomeh Eivazian

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20220302131442

FACILITY NAME:	FOOTHILL PROGRESSIVE MONTESSORI SCHOOL		FACILITY NUMBER:	198015149
ADMINISTRATOR:	KANTHI DE SILVA		FACILITY TYPE:	850
ADDRESS:	827 HOUSEMAN STREET		TELEPHONE:	(818) 952-7232
CITY:	LA CANADA	STATE: CA	ZIP CODE:	91011
CAPACITY:	62	CENSUS: 57	DATE:	03/09/2022
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Kanthi De Silva, Licensee		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Lack of supervision resulting in injury to daycare child

INVESTIGATION FINDINGS:

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At 9:40 a.m. Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced complaint inspection in regards to the above allegation on 03/09/2022. LPA met with Kanthi De Silva, director/licensee who guided analyst on a tour of the facility. During this inspection there were total of 57 children present in the facility with 9 staff.

Interviews were conducted with staff. LPA Eivazian watched video footage in the facility office area for 03/01/2022 from 9:00 a.m. to 10:00 a.m. from bike area and back outdoor area.

Based on interviews that was conducted with staff#1, staff#2 and staff#3 they did not observe child #1 to fell down to sustain any marks on the face or right arm. Per staff#1, on 03/01/2022 while they were on the back outdoor area child#1 came to staff#1 crying. Per staff#1, child#1 was checked and asked what happened, child#1 did not say why crying and staff#1 did not observe any red marks on child#1.
REPORT CONTINUES ON NEXT PAGE 1 of 2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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 3

Control Number 33-CC-20220302131442

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FOOTHILL PROGRESSIVE MONTESSORI SCHOOL	FACILITY NUMBER: 198015149
	VISIT DATE: 03/09/2022

NARRATIVE

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On 03/09/2022 LPA Eivazain watched video footage from 03/01/2022 from bike area and back outdoor area from 9:00 a.m. to 10:00 a.m. with staff#4. LPA observed child#1 was playing on the grass area by basketball pole in back outdoor playarea and at 9:55 a.m. ran straight from the pole to the wall, came back and fell down on the cement walking path and child#1's right hand and right side of the face touched the cement, stood up and walked while crying. LPA Eivazian checked the back outdoor playarea where child#1 fell down and observed outdoor back playarea in a safe condition free of hazards.

Per LPA Anomeh Eivazian's request during this inspection director, Kanthi De Silva showed the video footage from 03/01/2022 where child#1 fell down to staff#1 and staff#2. Staff#1 and staff#2 stated they did not observe the incident where child#1 fell down. Staff#2 stated, child#1 came to staff#2 while crying.

Per facility director and record review, on 03/01/2022 there were total of 19 children present in (2-3 year old) classroom with three staff.

Based on LPA observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated at this time.

The following deficiency listed on the attached LIC 809 (deficiency page) is being cited in accordance with California Code of Regulations Title 22. Deficiency that is being cited need to be cleared by plan of correction due date to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee/Director Kanthi De Silva at 2:00 p.m..

REPORT END 2 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 33-CC-20220302131442

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FOOTHILL PROGRESSIVE MONTESSORI SCHOOL	FACILITY NUMBER: 198015149
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/18/2022 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by...	1 2 3 4 5 6 7	Per facility director, teacher child ratio was met on 03/01/2022, there were 3 staff with 19 children for 2-3 year old classroom. Per director she will conduct a training to staff for more active care and supervision while indoor and outdoor and will show Supervising Children in Child Care Centers video from CCLD website.
	8 9 10 11 12 13 14	Based on staff interviews and video footage watched from 03/01/2022, child#1 fell down and child#1's right hand and right side of face touched the cement ground at 9:55 a.m. on while on the back outdoor playarea and cried and teachers did not observe it. This poses a potential health and safety risk to the children in care.	8 9 10 11 12 13 14	A written plan will be submitted to LPA by plan of correction due date.
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	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: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC9099 (FAS) - (06/04)

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