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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343614059
Report Date: 12/22/2021
Date Signed: 12/22/2021 11:50:51 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
12/07/2021 and conducted by Evaluator Jan Hoshida
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20211207081241
FACILITY NAME:LITTLE BLOSSOM MONTESSORI SCHOOL, INC.FACILITY NUMBER:
343614059
ADMINISTRATOR:PHILLIPS, FELICIAFACILITY TYPE:
850
ADDRESS:2075 ARENA BLVDTELEPHONE:
(916) 515-0550
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:165CENSUS: 22DATE:
12/22/2021
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Subashini Ranatanga and Lakshman RanatungaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Personal Rights: Staff hit day care child.
INVESTIGATION FINDINGS:
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On 12/22/2021 at 8:45am, Licensing Program Analyst (LPA) Jan Hoshida met with Administrator Lakshman (Lucky) Rantunga to close a complaint investigation to deliver findings and conclude the complaint investigation of the above allegation. LPA conducted a health and safety inspection. Upon arrival, there were 22 day care children supervised by five staff during the inspection. Director Subashini Ranatanga arrived at the facility at 11:15am.

During the investigation, LPA conducted a health and safety inspection the facility, conducted observations of staff and children both indoors and out, and conducted interviews with pertinent parties. LPA reviewed facility files, video surveillance of the facility, and obtained records relevant to the complaint investigation.
It was alleged that staff #1 hit day care child. Based on staff interviews, staff #1 has tapped day care children on their heads or foreheads to help them focus or pay attention which is a personal rights violation. Staff stated that they understand that this is not appropriate and will no longer tap the day care children on the heads or foreheads.

REPORT CONTINUED ON NEXT PAGE
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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 03-CC-20211207081241
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: 343614059
VISIT DATE: 12/22/2021
NARRATIVE
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Based on parent interviews, three of the nine parents interviewed had concerns about the discipline techniques of staff #1. Based on day care children interviews, two children stated that staff #1 has flicked or poked their cheek or neck and that it made them feel bad. LPA observed on video surveillance staff #1 tapping the foreheads of two children while they were sitting at a table.

LPA discussed the importance of personal rights with staff and administration.

Based on LPA's interviews and observations, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Title 22 deficiencies are cited on the subsequent pages of this report. Administrator acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, Administrator shall post LIC 9099-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Administrator. LIC 9224 and Appeal Rights were provided. An exit interview was conducted and a Notice of Site Visit was posted.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20211207081241
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: 343614059
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/23/2021
Section Cited
CCR
101223(a)(3)
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Personal Rights. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication
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Facility will conduct a mandatory training staff on personal rights and will provide staff signatures to LPA by 12/23/2021.
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or aids to physical functioning. This requirement is not met as evidenced by:
Based on interviews and video surveillance, LPA determined that facility staff #1 tapped or flicked day care children on the head and forehead. This poses an immediate health, safety, or personal rights risk to 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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3