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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343613062
Report Date: 08/08/2019
Date Signed: 08/08/2019 09:55:31 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2019 and conducted by Evaluator Christopher Bello
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20190725155555
FACILITY NAME:LITTLE BLOSSOM MONTESSORI SCHOOL, INC.FACILITY NUMBER:
343613062
ADMINISTRATOR:CHAYA SENARATH, GALLOLUWEFACILITY TYPE:
830
ADDRESS:2075 ARENA BLVD.TELEPHONE:
(916) 515-0550
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:40CENSUS: 12DATE:
08/08/2019
UNANNOUNCEDTIME BEGAN:
07:15 AM
MET WITH:Lucky RanatungaTIME COMPLETED:
10:10 AM
ALLEGATION(S):
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Lack of supervision - There are times when the children are left with no supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christopher Bello met with owner/administrator Lucky Ranatunga and Felicia Phillips to close a complaint investigation, regarding the above allegation. Upon arrival, LPA observed seven infants with two teachers and six toddlers with two teachers. During the investigation LPA made observations, gathered documents and interviewed staff and parents. Parent and staff interviews corroborated the allegation that at times there is a lack of supervision in the toddler rooms specifically during daiper changes. Based on LPAs' investigation, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED.

Title 22 deficiencies are cited on the subsequent page of this report. Type Acknowledgement forms are to be signed by current parent of the facility and new parents for the next twelve months. LIC 9224 and Appeal Rights were provided. An exit interview was conducted and a Notice of Site Visit posted which must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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 2
Control Number 03-CC-20190725155555
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LITTLE BLOSSOM MONTESSORI SCHOOL, INC.
FACILITY NUMBER: 343613062
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/09/2019
Section Cited
CCR
101429(a)(1)
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Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended. This is not met by evidence: Children during daiper changes are
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Administrator stated that they are going to look at changing the daiper changing table in a better position or add another teacher to the room for supervision by POC date: 8/9/19.

LPA will return to clear POC.
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sometimes left without direct visual supervision because of where the daiper changing table placement. This is considered as an immediate risk to the children in care.
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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2