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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408869
Report Date: 08/26/2022
Date Signed: 08/26/2022 01:18:17 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
08/25/2022 and conducted by Evaluator Arminder Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220825102438
FACILITY NAME:KEYSTONE MONTESSORI SCHOOLFACILITY NUMBER:
073408869
ADMINISTRATOR:PATHAK, ROHINIFACILITY TYPE:
850
ADDRESS:6639 BLAKE STREETTELEPHONE:
(510) 709-5853
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:57CENSUS: 9DATE:
08/26/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rohini PathakTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Reporting Requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Arminder Singh met with Director, Rohini Pathak regarding the above allegation. It was alleged the facility did not report COVID-19 exposure to CCLD. Director states that facility did have staff and children who tested positive and failed to notifidy CCLD in a timely manner. Director was not aware she was required to notifiy CCLD of the positive test results based on the new county guildelines. It is noted that Director has reported in the past of all COVID positive and exposures to CCLD.

Per LPA's interviews conducted, it was determined, 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.

The facility was provided a copy of the appeal rights. An exit interview was conducted and a copy of the complaint investigation report was provided and Notice of Site was issued.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
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 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
08/25/2022 and conducted by Evaluator Arminder Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220825102438

FACILITY NAME:KEYSTONE MONTESSORI SCHOOLFACILITY NUMBER:
073408869
ADMINISTRATOR:PATHAK, ROHINIFACILITY TYPE:
850
ADDRESS:6639 BLAKE STREETTELEPHONE:
(510) 709-5853
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:57CENSUS: 9DATE:
08/26/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rohini PathakTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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9
Staff are not taking precautions for COVID-19
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Arminder Singh investigated the above allegation and met with Director, Rohini Pathak. LPA has conducted interview, made visual observations, and obtainted a current children's roster.

It was alleged staff are not taking precautions for COVID-19. Facility policy when an exposure occurs, staff are required to wear masks in the presence of children and children are require to wear masks as much as possible.

LPA observed during today's visit staff were wearing masks inside and outside of the facility. Some children were observed to be wearing masks and some were not.

Based on the investigative finginds although the allegation may have happened or be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

The facillity was provided a copy of the appeal rights. An exit interview was conducted and a copy of the complaint investigation report was provided and Notice of Site was issued.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 02-CC-20220825102438
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: KEYSTONE MONTESSORI SCHOOL
FACILITY NUMBER: 073408869
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2022
Section Cited
CCR
101212(d)(1)
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101212(d)(1)(C) Reporting Requirements. Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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By 09/26/222 Dirctor will send in writing to LPA her understanding of the reporting requirements.
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Based on LPA's interview with Director it was stated that Director was not aware she was required to notifiy CCLD of the positive test results based on the new county guildelines. It is noted that Director has reported in the past of all COVID positive and exposures to CCLD.
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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: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4