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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412618
Report Date: 11/20/2023
Date Signed: 11/20/2023 02:04:12 PM

Document Has Been Signed on 11/20/2023 02:04 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MONTESSORI CHILDREN'S CENTERFACILITY NUMBER:
013412618
ADMINISTRATOR:SALVADOR, LULETTEFACILITY TYPE:
850
ADDRESS:33170 LAKE MEAD DRIVETELEPHONE:
(510) 489-7510
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 110TOTAL ENROLLED CHILDREN: 49CENSUS: 36DATE:
11/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lulette SalvadorTIME COMPLETED:
02:00 PM
NARRATIVE
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On Monday 11/20/2023 at 9:45AM, Licensing Program Analysts (LPAs) Jaleesa Jackson and Morgan Pringle conducted a complaint visit at the facility. LPA met with Director Lulette Salvador and explained the nature of the visit. Present on this visit were 36 preschool aged children and 8 staff.

At 10:00AM LPAs toured the upstairs area of the facility. LPAs observed 1 adult (A1) without a criminal record clearance upstairs. Director was informed that A1 must submit fingerprints to obtain a criminal record clearance by tomorrow 11/21/2023.

There was 1 deficiency cited on today's visit. See 809-D for deficiency.

LPAs informed facility representative Lulette Salvador that this report dated 11/20/2023 document 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed the facility representative to provide a copy of this licensing report dated 11/20/2023 that documents any Type A citation 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.

A notice of site visit was given and must remain posted for 30 days.



Appeal rights were printed and given to Director.

Exit interview conducted and report was reviewed with the Director Lulette Salvador.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
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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Document Has Been Signed on 11/20/2023 02:04 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 11/20/2023 at 12:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI CHILDREN'S CENTER
FACILITY NUMBER: 013412618

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2023
Section Cited
CCR
101170(e)(1)

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101170(e)(1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing ... in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department...
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Director will immediately have A1 submit fingerprints to obtain a criminal record clearance by tomorrow 11/21/2023 and send proof to LPA by email.
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This requirement is not met as evidenced by: Based on observation, interview, and record review licensee has an unclear adult residing in the facility which poses an immediate risk to the health, safety, and personal rights to 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.
SUPERVISOR'S NAME:Jason Jang
LICENSING EVALUATOR NAME:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2023


LIC809 (FAS) - (06/04)
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