304371475-3-11-2022-06-CC-THOO-CE9LEJ-20220509084136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371475
Report Date: 03/11/2022
Date Signed: 03/11/2022 03:36:33 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/28/2022 and conducted by Evaluator Tina Nguyen

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20220228141122

FACILITY NAME:	BUENA PARK MONTESSORI ACADEMY		FACILITY NUMBER:	304371475
ADMINISTRATOR:	GUNASEKARA, HISSANKA S.		FACILITY TYPE:	830
ADDRESS:	6221 LINCOLN AVENUE		TELEPHONE:	(714) 821-7800
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	27	CENSUS: 17	DATE:	03/11/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Director Savithri De Alwis, Hissanka Gunasekara, CEO, Sali Gunasekara		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Two children found outside without any supervision

INVESTIGATION FINDINGS:

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On 03/11/2022, Licensing Program Analyst (LPA) Tina Nguyen and Licensing Program Manager (LPM) conducted a tele inspection to deliver the findings regarding the above complaint allegations. LPA Nguyen met with director Savithri De Alwis, Secretary Hissanka Gunasekara, President Sali Gunasekara . There was a total of 17children and 4 staff members. A review of staff criminal clearance records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 02/28/2022, Licensing office received a complaint alleging Two children were found outside the facility without any supervision. Reporting party 1 (RP#1) indicated that on 02/28/2022, RP#1 witnessed two female children walking down the street from the facility. RP#1 indicated that RP #1 and another witness (Reporting party #2, RP2) was driving on the first lane near the sidewalk and noticed two little toddlers walking unattended; (continue on page 2)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina Nguyen	TELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

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 6

Control Number 06-CC-20220228141122

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 03/11/2022

NARRATIVE

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C1 was about to step into the street and C2 was on the sidewalk following the first child; RP#2 pulled over as fast as RP#2 could and RP#1 jumped out of the car as the car was still rolling and RP#1 ran approx. 20 ft a second car stopped person driving is another witness (Reporting party #3 (RP3)), RP#3 immediately stopped and waved down the oncoming traffic a big dumpster truck RP#3 grabbed the first child out from the rear of RP#3’s car about to enter the second lane of the Blvd. RP#1 and two others witnessed picked up the children and returned child#1 and Child#2 to the daycare. The RP called 911, code enforcement, and Licensing office.

During the staff interview, Staff #4 (S4) disclosed to LPA Nguyen that on 2/28/2022, Child #1 (C1) and Child #2 (C2) who were under the care and supervision of staff #1 (S1) and Staff#2 (S2) opened the playground gate and ran to the parking lot, which led to the street approximately 200 feet from the facility. There’s the video footage depicts one child opening the playground gate and the 2 children running out of the playground gate. Another child walked outside of the gate but returned to the playground. The video showed the children left at 11:51:42 second and the witnesses brought the 2 children back at 11:53:18 second. No staff members were seen in the video footage. During the staff interview, S1, S2, S3, and S4 admitted a child opened the playground gate and 2 children ran out of the playground gate toward Lincoln Street. Interviewed staff members indicated that this was the first time an incident like this occurred and the gate has been in working condition.

LPA Nguyen attempted to interview C1, but due to C1’s age and limited speech, LPA was not able to qualify the child.

During the inspection on 3/2/2022, LPA Nguyen observed facility installed a new alarm system on all exit gates. LPA Nguyen tested the alarm by opening one of the gates and there was an alarm sound when the gate was opened.

Based on the information obtained from interviews, the facility staff failed to provide adequate supervision resulting in 2 daycare children wandering away from the facility. The preponderance of evidence standard has been met, therefore allegation: Two children found outside without any supervision is found to be substantiated.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina Nguyen	TELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 06-CC-20220228141122

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 03/11/2022

NARRATIVE

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The facility was cited type A violation under California Code of Regulations, Title 22, Division 12 & Chapter 1, Article 6 Continuing Requirements 101229 (a) (1) Responsibility for Providing Care and Supervision. Please refer to the attached 9099D for documentation of deficiency

This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

Exit interview was conducted. The administrator was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First-level appeals should be sent to the regional manager to the address listed above.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina Nguyen	TELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/28/2022 and conducted by Evaluator Tina Nguyen

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20220228141122

FACILITY NAME:	BUENA PARK MONTESSORI ACADEMY		FACILITY NUMBER:	304371475
ADMINISTRATOR:	GUNASEKARA, HISSANKA S.		FACILITY TYPE:	830
ADDRESS:	6221 LINCOLN AVENUE		TELEPHONE:	(714) 821-7800
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	27	CENSUS: 17	DATE:	03/11/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Director Savithri De Alwis, Hissanka Gunasekara, CEO, Sali Gunasekara		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Gate is not working

INVESTIGATION FINDINGS:

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On 03/11/2022, Licensing Program Analyst (LPA) Tina Nguyen and Licensing Program Manager (LPM) conducted a tele inspection to deliver the findings regarding the above complaint allegations. LPA Nguyen met with director Savithri De Alwis, Hissanka Gunasekara, CEO, Sali Gunasekara . There was a total of 4 staff members and 17 children. A review of staff criminal clearance records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
On 03/01/2022, Licensing office received a complaint alleging Gate is not working. Reporting party RP stated that two female children opened the playground gate and walked down the street and the playground gate was not working.
During the staff interview, Staff #4 (S4) disclosed to LPA Nguyen that on 2/28/2022, Child #1 (C1) and Child #2 (C2) who were under the care and supervision of staff #1 (S1) and Staff#2 (S2) opened the playground gate and ran to the parking lot, which led to the street approximately 200 feet from the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina Nguyen	TELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

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

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 06-CC-20220228141122

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 03/11/2022

NARRATIVE

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There’s the video footage depicts one child opening the playground gate and the 2 children running out of the playground gate. Another child walked outside of the gate but returned to the playground. The video showed the children left at 11:51:42 second and the witnesses brought the 2 children back at 11:53:18 second. No staff members were seen in the video footage. During the staff interview, S1, S2, S3, and S4 admitted a child opened the playground gate and 2 children ran out of the playground gate toward Lincoln Street. Interviewed staff members indicated that this was the first time an incident like this occurred and the gate has been in working condition.

During the inspection on 3/2/2022, LPA Nguyen observed facility installed a new alarm system on all exit gates. LPA Nguyen tested the alarm by opening one of the gates and there was an alarm sound when the gate was opened.

Based on the information gathered from LPAs' interviews, observation, and reviewing records, there is insufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged Gate is not working did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted. Notice of Site Visit was posted during the visit. The administrator was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First-level appeals should be sent to the regional manager at the address listed above.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina Nguyen	TELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 06-CC-20220228141122

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/11/2022 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision: a) The licensee shall provide care and supervision as necessary to meet the children's needs.1) No child(ren) shall be left without the supervision of a teacher at any time...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The director stated they already provided the care and supervision training on 3/9/2022 to all staff members. The facility also already installed a new alarm system on all exit playground gates.
	8 9 10 11 12 13 14	Based on interviews and statements provided, the facility staff failed to provide adequate supervision resulting in 2 daycare children wandering away from the facility. This poses an immediate risk to the health and safety of the children in care.	8 9 10 11 12 13 14	$500 civil penalty is being assessed during today’s tele inspection.
	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: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina Nguyen	TELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

LIC9099 (FAS) - (06/04)

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