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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430710472
Report Date: 08/23/2021
Date Signed: 08/23/2021 03:02:43 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
06/02/2021 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210602081234
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: 129DATE:
08/23/2021
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Spyroula Rodenborn & Sandra KissTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Child sustained injury in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mel Matos conducted an unannounced follow up complaint investigation and met with Spyroula Rodenborn, Executive Director, and Sandra Kiss, HR Director. Purpose of today's follow up complaint investigation: deliver investigation findings. The investigation of the above allegation was conducted by Licensing Program Analyst Mel Matos. Based on interviews, record reviews, observations, and evidence gathered during the investigation process, the Department determines that a child did sustain an injury in care as a result of the child running into an iron support pole in the hallway area (located near Rooms H-3 & H-4). The hallway area is not approved outdoor space. It is thus concluded that the above allegation is found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met. A "Type A" deficiency is being cited on the attached LIC 9099-D.

NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED ALONG WITH A COPY OF TODAY'S REPORT FOR 30 DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 07-CC-20210602081234
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: 08/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2021
Section Cited
CCR
101223(a)(2)
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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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The Facility agreed to submit a written Plan of Correction by Wednesday August 25, 2021 which states that children shall only play outdoors in outdoor space that is approved by the Department. The Facility shall also provide proof of notification to all staff.
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This requirement was not met as evidenced by: a child sustained an injury in care as a result of the child running into an iron support pole in the hallway area (located near Rooms H-3 & H-4). The hallway area is not approved outdoor space.
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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.
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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: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
LIC9099 (FAS) - (06/04)
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