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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073405005
Report Date: 11/20/2023
Date Signed: 11/20/2023 02:21:26 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2023 and conducted by Evaluator Ashley Curry
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20231116150855
FACILITY NAME:A LITTLE WORLD MONTESSORI ACADEMYFACILITY NUMBER:
073405005
ADMINISTRATOR:SAMUDRA DE ALWISFACILITY TYPE:
850
ADDRESS:355 PARKER AVETELEPHONE:
(510) 799-6361
CITY:RODEOSTATE: CAZIP CODE:
94572
CAPACITY:34CENSUS: 7DATE:
11/20/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Samudra De AlwisTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff member handles day care children in care in a rough manner.
INVESTIGATION FINDINGS:
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On 11/20/2023 at 10:30AM Licensing Program Analyst (LPA), A. Curry arrived at the facility to conduct an unannounced complaint inspection. LPA was greeted by Teacher, Mary Qader and the Director, Samundra De Alwis, who arrived at the facility shortly after. LPA met the Director to discuss the above allegation. LPA made observations, retrieved documentation, and conducted interviews with staff and children. Based on the information gathered through interviews, it was determined that the director disciplined children in a rough manner. Based on the interviews, the preponderance of evidence standard has been met. Therefore the above allegation is found to be SUBSTANTIATED. Violations of the California Code of Regulations, Title 22, Division 12, Section 101223(a)(1)(3) is being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2023 and conducted by Evaluator Ashley Curry
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20231116150855

FACILITY NAME:A LITTLE WORLD MONTESSORI ACADEMYFACILITY NUMBER:
073405005
ADMINISTRATOR:SAMUDRA DE ALWISFACILITY TYPE:
850
ADDRESS:355 PARKER AVETELEPHONE:
(510) 799-6361
CITY:RODEOSTATE: CAZIP CODE:
94572
CAPACITY:34CENSUS: 7DATE:
11/20/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Samudra De AlwisTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff member speaks inappropriately to day care child(ren) in care.
INVESTIGATION FINDINGS:
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On 11/20/2023 at 10:30AM Licensing Program Analyst (LPA), A. Curry arrived at the facility to conduct an unannounced complaint inspection. LPA was greeted by Teacher, Mary Qader and the Director, Samundra De Alwis, who arrived at the facility shortly after. LPA met the Director to discuss the above allegation. LPA made observations, retrieved documentation, and conducted interviews with staff and children. Based on the information gathered through interviews it could not be determined that staff speak to children inappropriately. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. This allegation is Unsubstantiated.

Exit interview conducted, appeal rights were given, and report was reviewed with the Director, Samudra De Alwis.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 02-CC-20231116150855
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: A LITTLE WORLD MONTESSORI ACADEMY
FACILITY NUMBER: 073405005
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
11/21/2023
Section Cited
CCR
101223(a)(1)(3)
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101223Personal Rights (a)The licensee shall ensure that each child...(1)To be accorded dignity in his/her personal relationships with staff..(3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat...
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By 11/21/2023 the Director will review the Personal Rights regulations and email a written statement ensuring she will comply with the regulations.


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This requirement is not met as evidence by:

Based on interviews, the Director disciplined childen in a rough manner, which poses an immediate risk to the health, safety, and personal rights of children in care.
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By 12/04/2023 the Director will enroll into a course that discusses appropriate forms of discipline. Director will email proof of enrollment to LPA.

Contact the Resource and Referral Agency for course recommendation.
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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.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 02-CC-20231116150855
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: A LITTLE WORLD MONTESSORI ACADEMY
FACILITY NUMBER: 073405005
VISIT DATE: 11/20/2023
NARRATIVE
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LPA A. Curry informed Director, Samudra De Alwis, that this report dated 11/20/2023 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA A. Curry informed the Director, Samudra De Alwis, to provide a copy of this licensing report dated 11/20/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted, appeal rights were given, and report was reviewed with the Director, Samudra De Alwis.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4