198018405-8-23-2022-33-CC-CGUA-CKCN4N-20221019100810

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198018405
Report Date: 08/23/2022
Date Signed: 08/23/2022 01:00:37 PM

Substantiated

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
08/19/2022 and conducted by Evaluator Fabiola Vasquez

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20220819085453

FACILITY NAME:	KEYSTONE MONTESSORI PRESCHOOL		FACILITY NUMBER:	198018405
ADMINISTRATOR:	BHAGYA WIJEWARDANE		FACILITY TYPE:	850
ADDRESS:	7056 WASHINGTON AVE.		TELEPHONE:	(562) 303-7273
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90602
CAPACITY:	53	CENSUS: 16	DATE:	08/23/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Bhagya Wijewardane, Owner Director		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Facility is not properly cleaned and sanitized.

INVESTIGATION FINDINGS:

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On 08/23/22 at 8:45 AM LPA Fabiola Vasquez conducted an unannounced 10 Day complaint inspection. LPA meet with Katrina Torrez, Teacher in room 112 who was supervising 13 children at 8:45 AM., LPA discussed the purpose of the visit was to investigate the above allegation. One child arrived, at 9:00 AM., second child arrive, at 9:04 AM., third child arrived at 9:05 AM., Staff # 2 (S2) arrived at 9:02 AM., LPA observed S2 stepped out of the classroom leaving Ms Torres with 16 children. Bhagya Wijewardane, Owner Director arrived at 9:15 AM., LPA explained the purpose of the visit is to investigate the above allegation. Owner Director guided LPA on tour of the facility.

Per director the only classrooms that are being used by the children are room 112, 115, 110.

Throughout the course of the investigation, an interview was conducted with Owner- Director, Documentation in the form of a Photos, LPA observations, Children Roster, Personnel Roster were obtained.
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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

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 33-CC-20220819085453

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: KEYSTONE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198018405
	VISIT DATE: 08/23/2022

NARRATIVE

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Pertaining to the allegation that “Facility is not properly cleaned and sanitized”. Complaint alleges that this matter has been addressed to teachers, and the director, but no action has been taken. Restrooms are disgusting, floors, tables, trash.

LPA interviewed Director who stated; I noticed the chair from that classroom, needs to be cleaned ( LPA observed a urine stain on the children's chair), another statement made by director, I noticed the carpet needs to be cleaned. I noticed sometimes the sinks needs to be cleaned. Its the teachers that use them all the time. LPA observed the bathrooms toilets in room 112, 115. 110 to have yellow ring stains inside and on the outer part of the the toilet, LPA observed the rugs in the classrooms to be dirty, LPA observed the classroom sinks have build up stains. LPA observed the floors have shoe mark stains.

Based on observations, interviews concluded and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22 101238(a) Buildings and Grounds, is being cited on the attached LIC 9099-D.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted with owner director Bhagya Wijewardane, during which appeal rights were given and explained.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC9099 (FAS) - (06/04)

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Control Number 33-CC-20220819085453

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: KEYSTONE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198018405
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/23/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/06/2022 Section Cited CCR 101238(a)	1 2 3 4 5 6 7	The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors This requirement was not met as evidenced by Per director, I noticed the carpet needs to be cleaned.	1 2 3 4 5 6 7	POC: Per director she hired a new cleaning lady. Per director she is going to have meeting regarding sanitization and cleaning. She is going to have the staff sign the memo. Director is planning to have annual trainings with her staff. Director has a Environment checklist she will modyfy. Provide proof by 09/06/22.
	8 9 10 11 12 13 14	I noticed sometimes the sinks needs to be cleaned. Its the teachers that use them all the time. LPA observed the bathrooms toilets in the rooms to have a yellow ring stains inside/outer part of the the toilets. This poses a potential risk to the health and safety of children in care	8 9 10 11 12 13 14
	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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC9099 (FAS) - (06/04)

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