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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408869
Report Date: 05/24/2023
Date Signed: 05/24/2023 02:52:49 PM

Document Has Been Signed on 05/24/2023 02:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
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: 57TOTAL ENROLLED CHILDREN: 57CENSUS: 49DATE:
05/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:PATHAK, ROHINITIME COMPLETED:
03:15 PM
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On May 17, 2023 at 1:45 PM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced Unusual/Incident Report follow up. LPA met with Director Pathak, Rohini.to discuss the incident that was reported on May 17, 2023 that a parent reported her child stated the teacher Ms Victoria hurt her arm. The parent had just came into the facility to pick up her children, She first stopped at the (2 1/2 - 3 ) year old classroom to pick up child and her daughter saw her and child opened the door completely in excitement trying to get to her mother and tries to run out the classroom, Teacher Victoria reacts and grabs the child by her arm to try and stop her from running out. Once the parent came in the classroom her child was saddened and advised mom that Ms Victoria hurt her. Director contacted the parent once she was advised from her administrative assistant of what occurred. Director has sent home Ms Victoria until this situation has been resolved.




SEE LIC 812 FOR CONTINUANCE..........
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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