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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010210145
Report Date: 03/20/2023
Date Signed: 03/20/2023 11:23:23 AM

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
02/22/2023 and conducted by Evaluator Catherine Fernandes
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230222104723
FACILITY NAME:CHILD UNIQUE MONT. SCHOOLFACILITY NUMBER:
010210145
ADMINISTRATOR:MASCORRO, MARISELAFACILITY TYPE:
850
ADDRESS:2212 PACIFIC AVE.TELEPHONE:
(510) 521-1030
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:20CENSUS: 12DATE:
03/20/2023
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Cindy AckerTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Unqualified staff caring for day-care children
Staff are operating over ratio
Unfingerprinted adults are providing care
INVESTIGATION FINDINGS:
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On 3/20/23, at 10:20AM, Licensing Program Analyst (LPA) Catherine Fernandes arrived unannounced to deliver the findings to the above allegations and met with owner Cindy Acker. Present in care were nine preschoolers and three toddlers with an additional four staff members. During the investigation LPA Fernandes did a walk through of the center, reviewed center files and conducted interviews with staff, and parents.
Regarding the first two allegations: Interviews and record review indicated that the center has had unqualified staff providing care and supervision to the children therefore the center has been out of ratio. While reviewing clearances for the staff members at the center LPA Fernandes observed staff 1 (S1) was cleared to be at the center but was not associated to the facility number. S1 started at the center on in October 2022 and was associated 2/24/23. Staff 3 (S3) has been at the center working with the children since September 2022 and got fingerprinted on 2/24/23. S3 was cleared to work at the center on February 27, 2023. Therefore, the above allegations are SUBSTANTIATED, the preponderance of evidence standard has been met.

Report continues on 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023
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
Control Number 02-CC-20230222104723
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: CHILD UNIQUE MONT. SCHOOL
FACILITY NUMBER: 010210145
VISIT DATE: 03/20/2023
NARRATIVE
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LPA Fernandes informed the licensee to provide a copy of this licensing report dated 3/20/23 that documents two Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Title 22, California Code of Regulation is being cited on the attached LIC 9099D.

Notice of site visit was provided and must be posted for 30 days.

Exit interview conducted.
Report, Appeal Rights, LIC9224 and provided
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20230222104723
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: CHILD UNIQUE MONT. SCHOOL
FACILITY NUMBER: 010210145
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/21/2023
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision- No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement has not been met as evidenced by:
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The center will reassess all classrooms and come up with a plan to ensure compliance, then send the plan to CCLD by Proof of correction date.

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Based on interviews and reviewed evidence the center has had aides providing care to the children causing the center to be out of ratio, which is an immediate risk to children in care.
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Type A
03/21/2023
Section Cited
CCR
10170(e)(1)
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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1)Obtain a California clearance or a criminal record exemption as required by the Department. This requirement has not been met as evidenced by:
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The center will review all staff member’s clearances and associations to reflect all current staff. Then send a statement of understanding and completion to CCL by proof of correction date.

A civil penalty of $500 has been assessed.
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Based on interviews and records staff 3 did not have a criminal record clearance and Staff 1 was not associated to the center, which poses an immediate risk to the children in care.

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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: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3