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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434412737
Report Date: 06/22/2022
Date Signed: 06/22/2022 12:37:36 PM

Substantiated


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
05/25/2022 and conducted by Evaluator James G Santos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220525092613
FACILITY NAME:ALKA MONTESSORI INCFACILITY NUMBER:
434412737
ADMINISTRATOR:ALKA SHARMAFACILITY TYPE:
850
ADDRESS:70 SOUTH SAN TOMAS AQUINOTELEPHONE:
(408) 871-0320
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:65CENSUS: 37DATE:
06/22/2022
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Alka SharmaTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Child's personal rights were violated
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), James Santos conducted an unannounced subsequent complaint visit investigation today and met with Licensee, Alka Sharma. The purpose of today's visit was to deliver the investigation finding for the above allegation.

During the course of the investigation, LPA conducted interviews staff and based on the interviews, the preponderance of evidence standard has been met, therefore the above allegatioin is found to be SUBSTANTIATED.

See LIC9099D page for deficiency cited. Exit interview conducted and copy of this report and appeal rights form provided to the Licensee.

NOTICE OF SITE VISIT WAS ISSUED TO LICENSEE AND WAS 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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
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 07-CC-20220525092613
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: ALKA MONTESSORI INC
FACILITY NUMBER: 434412737
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/23/2022
Section Cited
CCR
101223(a)(1)(3)
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101223 Personal Rights
(a)The licensee shall ensure that each child is accorded the following personal rights:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.
(3) 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:
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Licensee and staff agreed and understood that each child receiving services at day care center are to be accorded dignity in his/her personal relationships with staff and other persons. Also, 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.
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interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement is not met as evidenced by: Based on the interview with staff, staff lifted a child's shirt during class time. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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Licensee agreed to discuss with staff about Personal Rights and staff agreed to take and complete Personal Right Training and Licensee will submit Proof of Correction to CCL by the POC due date, 6/23/2022.

According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months and copy of signed acknowledgement form must be kept in each child's file.
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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2