<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343616499
Report Date: 10/03/2019
Date Signed: 10/03/2019 10:13:58 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
09/23/2019 and conducted by Evaluator Kelly Ferrara
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20190923142718
FACILITY NAME:FOLSOM LAKE MONTESSORI ACADEMYFACILITY NUMBER:
343616499
ADMINISTRATOR:KUDUPUDI, UMARAJESWARIFACILITY TYPE:
830
ADDRESS:196 BLUE RAVINE RD. STE 150TELEPHONE:
(916) 351-9448
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:12CENSUS: 10DATE:
10/03/2019
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Uma KudupudiTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility equipment is not being used for its intended purpose
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Kelly Ferrara and Jan Hoshida conducted a complaint investigation inspection at the facility and met with owner Umarajewari Kudupudi. During today's inspection there were ten infant children present being supervised by three staff. LPAs interviewed the Owner, staff, and the reporting party during the investigation.
It was alleged that staff are using a rolling crib in order to bring the children from the classroom to the outside play area and are pushing it around outside as if taking the infants for a walk. Reporting party stated they have seen up to four infants placed in the crib at one time to go outside. LPAs observed this practice when staff used a rolling crib to take one infant from the classroom to the outside play area and the Owner confirmed that this is happening on a daily basis. LPAs advised that this is not the intended use for a crib. Owner stated that she thought that under Title 22 regulations, strollers were not allowed or she would have been using a stroller for this purpose. The allegation is determined to be substantiated, meaning that the preponderance of evidence standard has been met, however the allegation does not rise to the level of a citation.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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-20190923142718
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: FOLSOM LAKE MONTESSORI ACADEMY
FACILITY NUMBER: 343616499
VISIT DATE: 10/03/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Owner was advised that strollers are permitted in centers. Owner stated she would cease the practice of using a rolling crib to take the infants for a walk and would purchase a stroller. Owner received an advisory note to use appropriate equipment for the infants.
Exit interview was conducted and Notice of Site was posted.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2