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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343616500
Report Date: 03/26/2021
Date Signed: 03/26/2021 02:17:21 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/14/2021 and conducted by Evaluator Kelly Ferrara
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210114151457
FACILITY NAME:FOLSOM LAKE MONTESSORI ACADEMYFACILITY NUMBER:
343616500
ADMINISTRATOR:KUDUPUDI, UMARAJESWARIFACILITY TYPE:
850
ADDRESS:196 BLUE RAVINE ROADTELEPHONE:
(916) 351-9448
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:85CENSUS: 23DATE:
03/26/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Uma KudupudiTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff handled child in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Kelly Ferrara and Alize Tillery contacted Owner Uma Kudupudi in order to deliver findings for the above allegation. Due to the Covid19 pandemic, the visit was conducted via tele-inspection on Face Time. LPAs verified that the program currently has 23 children in care with four staff. During the investigation, LPA Ferrara interviewed the Reporting Party, Owner, three staff, two parents, and two children.

It was alleged that Staff #1 grabbed a child by the arms and dragged them into another classroom. Two out of two children interviewed stated that this occurred because the child was being noisy, and the action was disciplinary. Consistent statements were made by staff that the child often exhibited unsafe behaviors such as climbing on counters and tables. LPA reviewed the facility’s parent handbook which states that they will document a child’s behaviors and inform the parents. There was no documentation of incidents or a behavior plan in place regarding how to handle the child’s behaviors.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
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 4
Control Number 03-CC-20210114151457
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: FOLSOM LAKE MONTESSORI ACADEMY
FACILITY NUMBER: 343616500
VISIT DATE: 03/26/2021
NARRATIVE
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There is nothing in the discipline policy stating staff will place hands on a child, or physically intervene when a child is exhibiting unsafe behavior. Staff #1 stated that in this incident, the child was not being safe by climbing on the table, therefore staff put their arm around the child’s waist and took them off the table when they did not listen to verbal instructions. Staff stated that after child was removed from the table, Staff #1 asked another staff to switch classrooms with them because they needed a break.

Based on the evidence obtained, LPA Ferrara determined that the allegation is substantiated, meaning that the preponderance of evidence standard has been met.

One Type A deficiency was cited on the attached LIC 9099D. Upon receipt of a Type A citation, licensee shall post and provide copies of the LIC 9099 D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 9099 D in each child's file.

A copy of this report was emailed to the facility and a Notice of Site was provided.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 03-CC-20210114151457
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: FOLSOM LAKE MONTESSORI ACADEMY
FACILITY NUMBER: 343616500
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/29/2021
Section Cited
CCR
101223(a)(3)
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Personal Rights- The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment… This requirement was not met as evidenced by: Interviews conducted with staff and children revealed that a child was physically handled by staff.
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Owners shall have staff watch the video regarding personal rights on the CCLD website and write a short paragraph on what they learned. Owners shall revise their discipline policies so that the personal rights of the children are protected and adhere to their written policies.
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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: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
LIC9099 (FAS) - (06/04)
Page: 4 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/14/2021 and conducted by Evaluator Kelly Ferrara
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210114151457

FACILITY NAME:FOLSOM LAKE MONTESSORI ACADEMYFACILITY NUMBER:
343616500
ADMINISTRATOR:KUDUPUDI, UMARAJESWARIFACILITY TYPE:
850
ADDRESS:196 BLUE RAVINE ROADTELEPHONE:
(916) 351-9448
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:85CENSUS: 23DATE:
03/26/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Uma KudupudiTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff made inappropriate statements to child.
INVESTIGATION FINDINGS:
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13
Licensing Program Analysts (LPAs) Kelly Ferrara and Alize Tillery contacted Owner Uma Kudupudi in order to deliver findings for the above allegation. Due to the Covid19 pandemic, the visit was conducted via tele-inspection on Face Time. LPAs verified that the program currently has children in care with staff. During the investigation, LPA Ferrara interviewed the Reporting Party, Owner, three staff, two parents, and two children.
It was alleged that Staff #1 made disparaging comments towards the child while the incident in the classroom was occurring. Inconsistent statements were made regarding inappropriate comments towards the child in this situation or in general. All of the people interviewed stated that staff and child interactions are typically positive.
Based on the evidence obtained, LPA determined that the allegation is unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it. A copy of this report was emailed to the facility and a Notice of Site was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
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