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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412619
Report Date: 03/04/2024
Date Signed: 03/04/2024 03:33:11 PM

Document Has Been Signed on 03/04/2024 03:33 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: 14DATE:
03/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Lulette SalvadorTIME COMPLETED:
03:45 PM
NARRATIVE
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On 03/04/2024 at 9:50AM, Licensing Program Analyst (LPA) Jaleesa Jackson conducted an unannounced Plan of Correction (POC) visit. LPA met with the Director Lulette Salvador and explained the purpose of today's visit. Present on this visit were 4 staff and 14 infants. Facility operates from The facility operates from Monday to Friday, 7:00AM - 6:00PM.

On 02/20/2024, LPA substantiated a Complaint and conducted a case management visit. The facility received 5 type A violations for Infant Safe Sleep.

The Director and LPA developed a POC with a submission due date on 02/21/2024. The Licensee submitted the Plan of Correction documents to the LPA by the POC date. All children's files have the signed LIC9224.

LPA generated a Letter of Deficiency Citations Cleared and provided a copy to the Director.

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

Exit interview conducted and report was reviewed with the licensee, Lulette Salvador.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
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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