434404878-1-26-2022-07-CC-DSTN-CB93VU-20220201173539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434404878
Report Date: 01/26/2022
Date Signed: 01/26/2022 10:27:08 AM

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
11/02/2021 and conducted by Evaluator Ofelia Calivo

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20211102085040

FACILITY NAME:	MARIPOSA MONTESSORI SCHOOL		FACILITY NUMBER:	434404878
ADMINISTRATOR:	REKHA MUNDKUR		FACILITY TYPE:	850
ADDRESS:	16548 FERRIS AVENUE		TELEPHONE:	(408) 356-8816
CITY:	LOS GATOS	STATE: CA	ZIP CODE:	95032
CAPACITY:	70	CENSUS: 29	DATE:	01/26/2022
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Rekha Mundkur		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Day care children are not wearing masks

Staff did not notify day care child's authorized representative of injuries

Staff did not prevent day care child from injuring self

Staff did not allow day care childs' authorized representative to observe

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ofelia Calivo conducted an unannounced follow-up complaint investigation and met with Director Rekha Mundkur. The purpose of today's follow-up complaint investigation is to deliver investigation findings.

The investigation of the allegations listed above was conducted by LPA Calivo. Based on observations and interviews completed for this complaint investigation, it is concluded that although the allegations noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

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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