<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408869
Report Date: 08/16/2023
Date Signed: 08/23/2023 01:39:39 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
05/31/2023 and conducted by Evaluator Nyeesha Blount
COMPLAINT CONTROL NUMBER: 02-CC-20230531093151
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: 26DATE:
08/16/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:PATHAK, ROHINITIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights ~ Staff pinched day-care child, Staff handled day-care child in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS IS AN AMENDED DOCUMENT OF THE ORIGINAL DOCUMENT DATED 8/16/23. THIS DOCUMENT IS BEING AMENDED TO REFLECT THE ORIGINAL LIC9099.

On August 16, 2023 at 8:45AM Licensing Program Analyst (LPA) Nyeesha Blount, conducted an Unannounced Complaint site inspection to deliver complaint findings. LPA met with Director Pathak, Rohini also present was (10) staff member's who are background cleared. LPA advised Director of the nature of the inspection. Current Census today is 26 children which consists of (6) toddlers, (20) preschoolers. LPA obtained a copy of the children's current roster, observations and staff interviews were conducted at the time of the inspection.

Based on LPA's observations which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, 101223(a)(3) is being cited on the attached LIC 9099 D.

The attached type A deficiency is cited today and must be corrected by the due date. An exit interview was conducted. Appeal rights were given and discussed. This report must be available for public review for 3 years. Notice of site visit was given.

Substantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
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 3
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
05/31/2023 and conducted by Evaluator Nyeesha Blount
COMPLAINT CONTROL NUMBER: 02-CC-20230531093151

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: 26DATE:
08/16/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:PATHAK, ROHINITIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights ~ Staff handled day-care child in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS IS AN AMENDED DOCUMENT OF THE ORIGINAL DOCUMENT DATED 8/16/23. THIS DOCUMENT IS BEING AMENDED TO REFLECT THE ORIGINAL LIC9099.

On August 16, 2023 at 8:45AM Licensing Program Analyst (LPA) Nyeesha Blount, conducted an Unannounced Complaint site inspection to deliver complaint findings. LPA met with Director Pathak, Rohini also present was (10) staff member's who are background cleared. LPA advised Director of the nature of the inspection. Current Census today is 26 children which consists of (6) toddlers, (20) preschoolers. LPA obtained a copy of the children's current roster, observations and staff interviews were conducted at the time of the inspection.

Based on LPA's observations which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations,101223(a)(3) is being cited on the attached LIC 9099 D.

The attached type A deficiency is cited today and must be corrected by the due date. An exit interview was conducted. Appeal rights were given and discussed. This report must be available for public review for 3 years. Notice of site visit was given.
Substantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
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 3
Control Number 02-CC-20230531093151
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: 08/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
08/16/2023
Section Cited
CCR
101223(a)(3)
1
2
3
4
5
6
7
101223(a)(3)Personal Rights(a) The licensee shall ensure that each child is accorded the following personal rights.
(3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

this requirement has not been met as evidenced by..

1
2
3
4
5
6
7
Director shall submit a written plan of correction by watching videos on Personal Rights explaining how the facility will ensure safe practice's with staff by POC date of September 18, 2023. Director will submit to LPA via email or Fax.
8
9
10
11
12
13
14
which poses an immediate risk to the children in care based on observation it was stated that a staff member was pinching the children in care violating children in care in a inappropriate manner as a form of discipline.
8
9
10
11
12
13
14
CCR
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3