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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710472
Report Date: 04/15/2021
Date Signed: 04/15/2021 10:52:43 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:RAINBOW MONTESSORI CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430710472
ADMINISTRATOR:SPYROULA RODENBORNFACILITY TYPE:
850
ADDRESS:790 DUANE AVENUETELEPHONE:
(408) 738-3261
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:378CENSUS: DATE:
04/15/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Dave Rodenborn & Sandra KissTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Mel Matos and Licensing Program Manager (LPM) Diana Stephenson conducted a scheduled informal office meeting (via FaceTime) with Operations Director, Dave Rodenborn, and Human Resources Director, Sandra Kiss. The purpose of today's meeting was to discuss the following issues: personal rights and care & supervision.

1) A complaint investigation completed on April 5, 2021 substantiated the allegations that 1) Staff force fed a day care child while in care and 2) staff inappropriately restrained a day care child while in care. The Facility was issued two "Type A" deficiencies (personal rights) on April 5, 2021 as a result of the two substantiated allegations.
The staff involved in the above noted allegations were terminated from employment. Note: Staff were also served immediate exclusions from Licensing. A written plan of correction addressing training on children's personal rights (dates of training: April 20, 21, & 22, 2021) has been submitted to Licensing. Proof of attendance will be submitted to Licensing upon completion of the training.

2) A preschool child from Room G2 left the Facility with the wrong parent on April 1, 2021. A staff person recognized the child and proceeded to follow and get the child back to the Facility. The Facility was cited one "Type B" deficiency (care and supervision) on April 8, 2021 as a result of the incident on April 1, 2021.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: RAINBOW MONTESSORI CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 430710472
VISIT DATE: 04/15/2021
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The Facility has implemented a policy in which at least one staff will be stationed by the entry to each classroom to ensure that children are signed out and released to the correct parent/authorized representative. A copy of the Plan of Correction was submitted to Licensing on April 8, 2021.

LPM Stephenson advised Dave and Sandra that if there are continued deficiencies cited for care & supervision, the Facility may be referred to legal for possible administrative action, which could include revocation of the Facility license. The Facility will be monitored more frequently to ensure that the Facility is in compliance with the Department regulations.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
LIC809 (FAS) - (06/04)
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