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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412619
Report Date: 02/20/2024
Date Signed: 02/20/2024 03:21:40 PM

Document Has Been Signed on 02/20/2024 03:21 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:
013412619
ADMINISTRATOR:SALVADOR, LULETTEFACILITY TYPE:
830
ADDRESS:33170 LAKE MEAD DRIVETELEPHONE:
(510) 489-7510
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 9DATE:
02/20/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Lulette SalvadorTIME COMPLETED:
03:00 PM
NARRATIVE
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On 02/20/2024 Licensing Program Analyst (LPA) Jaleesa Jackson conducted an unannounced case management visit. LPA met with Director Lulette Salvador. Present for the inspection was 4 staff and 9 infants in care.

During visit LPA observed one infant was being put to sleep on their stomach. The infant does not have a medical exemption on file. LPA reminded Director that all infants under 12 months old the starting sleep positions are to be on their back. LPA also observed a drop down crib that was in use by a child. LPA let Director know that drop down cribs are not to be in child care per the United States Consumer Product Safety Commission and that the crib needs to be removed immediately. Director had the crib removed from the classroom. LPA also observed 2 cribs with blankets attached to the sides of the cribs. LPA let Director know that safe sleep regulations state that nothing is to be attached to cribs. LPA observed that 4 out of 6 infants strapped into feeding chair without food or bottles in front of them. LPA informed Director that children need to be actively eating or need to be removed from the chairs.

See 809-D for deficiencies cited during today's inspection.

LIC 9224 was issued and discussed.

Exit interview conducted with Lulette Salvador and appeal rights provided.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document Has Been Signed on 02/20/2024 03:21 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 02/20/2024 at 01:58 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: 013412619

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2024
Section Cited
CCR
101439.1(b)

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A crib or portable-crib meeting United States Consumer Product Safety Commission safety standards shall be provided for each infant who is unable to climb out of a crib.
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Director is to immediately remove the drop down crib from the facility. Proof that is discarded must be sent to LPA.
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This requirement was not met as evidenced by:
Based on observation, Licensee has a drop down crib in the facility which posed an immediate risk to the health and safety of children in care.
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Type A
02/21/2024
Section Cited
CCR101439.1(f)(3)

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There shall be no objects hanging above or attached to the side of the crib.
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Director is to remove the items. Director is to immediately have an all staff meeting regarding safe sleep for infants. The agenda will include the following. Reviewing all safe CCLD safe sleep regulations. Reviewing the safe sleep video on https://safetosleep.nichd.nih.gov/resources/videos.
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This requirement was not met as evidenced by:
Based on observation, two out of the seven cribs had a blanket attached to the sides which posed an immediate risk to the health and safety of children in care.
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Director will submit to LPA by email:
The agenda, sign in sheet of all staff present, and statements from all staff about how they will stay in compliance with the safe sleep regulations.
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: 02/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/20/2024 03:21 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 02/20/2024 at 02:25 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: 013412619

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2024
Section Cited
CCR
101430(a)(3)(A)

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Staff shall place infants up to 12 month of age on their backs for sleeping.
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Director is to immediately have an all staff meeting regarding safe sleep for infants. The agenda will include the following. Reviewing all safe CCLD safe sleep regulations. Reviewing the safe sleep video on https://safetosleep.nichd.nih.gov/resources/videos.
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This requirement was not met as evidenced by:
Based on observation, one infant was being put to sleep on her stomach which posed an immediate risk to the health and safety of children in care.
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Director will submit to LPA by email:
The agenda, sign in sheet of all staff present, and statements from all staff about how they will stay in compliance with the safe sleep regulations.

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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: 02/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/20/2024 03:21 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 02/20/2024 at 02:34 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: 013412619

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/05/2024
Section Cited
CCR
101223(a)(7)

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The licensee shall ensure that each child is accorded the following personal rights: Not to be placed in any restraining device. Postural supports may be used as specified in Section 101223.1.
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Director will have each staff member write a statement that infants will not be put in feeding chairs unless they have food in front of them or are actively eating and that the feeding chairs will be used accordingly.
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This requirement was not met as evidenced by:
Based on observation, 4 infants were strapped into feeding chair that were not actively eating or had food in front of them which poses an potential risk to the health and safety of 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: 02/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024


LIC809 (FAS) - (06/04)
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