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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343614059
Report Date: 01/21/2020
Date Signed: 03/12/2020 11:24:54 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
01/06/2020 and conducted by Evaluator Christopher Bello
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20200106154557
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: 61DATE:
01/21/2020
UNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Lucky RanatungaTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Facility staff are not properly supervising children in care.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Christopher Bello and Mai Lor met Owner Administrator Lucky Rantunga to amend a report previously dated 1/21/2020. Today’s census was 89 children. Throughout the investigation LPA obtained documents pertaining to the investigation, made observations and conducted interviews. During today’s inspection on 3/11/2020 LPA observed a child left alone unattended without visual supervision in the restroom. LPA observed that the teacher responsible for the child alone in the restroom was approximately 33 feet away at the door exiting to the playground. LPA observed that the Teacher was positioned facing the playground with her back turned to the restroom which does did not allow for visual supervision of the child. Lucky stated that the teacher should of went inside to stand near the entrance of the restroom to provide supervision to the child. 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: 01/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020
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
Citations on this Visit Report are Under Appeal!

Control Number 03-CC-20200106154557
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: 01/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
03/12/2020
Section Cited
CCR
101229(a)(1)
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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 has not been met by evidence: LPA observed a child left unattended without
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LPA will return to clear the deficiency.
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visual supervision in the restroom. This is considered as an immediate risk to the children in care.

**THIS IS AN AMENDED REPORT**
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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: 01/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2