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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430710472
Report Date: 04/05/2021
Date Signed: 04/06/2021 04:46:58 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/05/2020 and conducted by Evaluator Marilou Monico
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20201105085408
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: 142DATE:
04/05/2021
ANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Dave Rodenborn & Sandra KissTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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9
Staff force fed a daycare child while in care
Staff inappropriately restrained a daycare child while in care
INVESTIGATION FINDINGS:
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2
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5
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7
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9
10
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13
Licensing Program Analyst (LPA) Marilou Monico conducted an announced tele-inspection via FaceTime with Operations Director, Dave Rodenborn, and Human Resources Director, Sandra Kiss, to deliver investigation findings. LPA advised Dave and Sandra that this Complaint Investigation Report (LIC 9099) will be emailed to the facility (dave@rainbow-montessori.com & sandra@rainbow-montessori.com). Facility's reply to the email within 24 hours will serve as acknowledgement that the report was received.

The investigation of the above allegations was conducted by Community Care Licensing Division (CCLD) investigator, Shannan Borton. Based on interviews, record reviews, and evidences gathered during the investigation process, the Department determines that a child was force fed and inappropriately restrained by staff. The two staff members involved were terminated from employment. Therefore, the above allegations are found to be SUBSTANTIATED, meaning the allegations are valid because the preponderance of the evidence standard have been met.

Type A deficiencies are being cited on the attached LIC 9099D form.

NOTICE OF SITE VISIT WAS ISSUED. DAVE & SANDRA WERE INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021
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 07-CC-20201105085408
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/06/2021
Section Cited
CCR
101223(a)(3)
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7
Personal Rights - The licensee shall ensure that each child is accorded the following 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 or aids to physical functioning.
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The two staff members involved were terminated from employment. Dave states that a written plan to ensure that an All Staff Training to review children's personal rights will be sent to Licensing within the next 24 hours. Copy of agenda and proof of attendance to be submitted to Licensing upon completion of the training.
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9
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This requirement was not met as evidenced by: Staff force fed a daycare child while in care. This poses an immediate risk to the health and safety to children in care.
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9
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14
Type A
04/06/2021
Section Cited
CCR
101223(a)(1)
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7
Personal Rights - The licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons.
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This deficiency will be corrected upon submission of the above Plan of Correction.
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This requirement was not met as evidenced by: Staff inappropriately restrained a daycare child while in care. This poses an immediate risk to the health and safety to children in care.
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14
Upon receipt, licensee shall post 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.
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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/05/2020 and conducted by Evaluator Marilou Monico
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20201105085408

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: 142DATE:
04/05/2021
ANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Dave Rodenborn & Sandra KissTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff caused an injury to a daycare child while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Marilou Monico conducted an announced tele-inspection via FaceTime with Operations Director, Dave Rodenborn, and Human Resources Director, Sandra Kiss, to deliver investigation findings. LPA advised Dave and Sandra that this Complaint Investigation Report (LIC 9099) will be emailed to the facility (dave@rainbow-montessori.com & sandra@rainbow-montessori.com). Facility's reply to the email within 24 hours will serve as acknowledgement that the report was received.

The investigation of the above allegation was conducted by Community Care Licensing Division (CCLD) investigator, Shannan Borton. Based on interviews, record reviews, and evidences gathered during the investigation process, the Department determines that although the allegation noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The allegation is deemed UNSUBSTANTIATED.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3