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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198011975
Report Date: 12/02/2021
Date Signed: 12/02/2021 03:52:18 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/20/2021 and conducted by Evaluator Raul Navarro
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20210920143911
FACILITY NAME:MONTESSORI ON ELM PRESCHOOL + KINDERGARTENFACILITY NUMBER:
198011975
ADMINISTRATOR:WIJEYEWICKREMA, CASSANDRAFACILITY TYPE:
850
ADDRESS:930 ELM AVENUETELEPHONE:
(562) 570-8080
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:94CENSUS: 44DATE:
12/02/2021
UNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Ayomi Rathnayaka TIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Lack of supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced complaint inspection on 12/2/21. LPA Navarro arrived at the facility at 1:53pm and met with Director Ayomi Rathnayaka. LPA conducted the inspection to deliver the findings to the above allegation. There were 44 children present during today's inspection.

During the course of the investigation, LPA Navarro toured the facility, interviewed the reporting party, children in care, parents, and staff. Interviews conducted did not disclose any corroborating information, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted Director Ayomi Rathnayaka, during which appeal rights (LIC 9058) were explained and their signature on this form acknowledges receipt of these forms.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
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 2
Control Number 54-CC-20210920143911
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI ON ELM PRESCHOOL + KINDERGARTEN
FACILITY NUMBER: 198011975
VISIT DATE: 12/02/2021
NARRATIVE
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The Notice of Site Visit (LIC 9213) was posted where the parent/guardian of children enter and exit the facility and must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2