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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013423061
Report Date: 12/05/2023
Date Signed: 12/05/2023 11:57:41 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2023 and conducted by Evaluator Lorraine Dacanay-Breaux
COMPLAINT CONTROL NUMBER: 52-CC-20231012145154
FACILITY NAME:AMBA BHAVANI LLC/DBA KEEN LEARNERS MONTESSORIFACILITY NUMBER:
013423061
ADMINISTRATOR:AMBERKER, KSHAMA N.FACILITY TYPE:
850
ADDRESS:38660 LEXINGTON ST.TELEPHONE:
(510) 396-2403
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:61CENSUS: 52DATE:
12/05/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kshama N AmberkerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Personal Rights - Child in care sustained unexplained bruising
INVESTIGATION FINDINGS:
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On December 5, 2023, Licensing Program Analysts (LPA) Lorraine Dacanay Breaux conducted an unannounced inspection to conclude a complaint investigation and met with the director, Kshama N Amberker and advised her the purpose of the inspection. There was 52 preschool age children and 10 additional staff (includes administrative staff).

During the course of the investigation, LPA conducted interviews with the staff, regarding the allegation that a "child in care sustained unexplained bruising". Based on the interviews and documents received, this agency has investigated the complaint alleging that child in care sustained unexplained bruising, although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted, notice of site visit is provided and must remain posted for 30 days. Appeal rights provided. Exit interview conducted with director, Kshama N. Amberker.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2023 and conducted by Evaluator Lorraine Dacanay-Breaux
COMPLAINT CONTROL NUMBER: 52-CC-20231012145154

FACILITY NAME:AMBA BHAVANI LLC/DBA KEEN LEARNERS MONTESSORIFACILITY NUMBER:
013423061
ADMINISTRATOR:AMBERKER, KSHAMA N.FACILITY TYPE:
850
ADDRESS:38660 LEXINGTON ST.TELEPHONE:
(510) 396-2403
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:61CENSUS: 52DATE:
12/05/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kshama N AmberkerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Other - Facility is operation outside of license terms and conditions
INVESTIGATION FINDINGS:
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On December 5, 2023, Licensing Program Analysts (LPA) Lorraine Dacanay Breaux conducted an unannounced inspection to conclude a complaint investigation and met with the director, Kshama N Amberker and advised her the purpose of the inspection. There was 52 preschool age children and 10 additional staff (includes administrative staff).

LPA conducted interviews with the staff regarding the allegation that the "facility is operation outside of license terms and conditions". Based on the interviews, review of documents and observations conducted, this agency has investigated the complaint alleging that facility is operation outside of license terms and conditions, the preponderance of evidence standard has been met, Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

LPAs discussed with director the seriousness of the substantiated finding for this complaint. Exit interview was conducted, the deficiency and plan of correction discussed, and appeal rights approved. Exit interview conducted with director, Kshama N. Amberker.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
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 52-CC-20231012145154
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AMBA BHAVANI LLC/DBA KEEN LEARNERS MONTESSORI
FACILITY NUMBER: 013423061
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2023
Section Cited
CCR
101161(a)
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101161(a) The licensee shall not exceed the conditions, limitations and capacity specified in the license.
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POC: By 12/20/23, Facility Director shall submit written plan for not exceeding the capacity limitations. This statement will include staff's children under the age of 2 years of age. Director will email: Lorraine.Dacanay-Breaux@dss.ca.gov
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This requirement was not met based upon interviews. LPA was informed that a child under the age of 2 years old was at the facility. This facility is licensed for children starting at the age of 2 years old. This poses a potential safety risk to the child and children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation.
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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: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC9099 (FAS) - (06/04)
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