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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013413922
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:42:10 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2023 and conducted by Evaluator Jaleesa Jackson
COMPLAINT CONTROL NUMBER: 52-CC-20231108153107
FACILITY NAME:NURTUREKIDS MONTESSORI, PRESCHOOL & EXTENDED CAREFACILITY NUMBER:
013413922
ADMINISTRATOR:RELAN, SHASHIFACILITY TYPE:
850
ADDRESS:38000 CAMDEN STREETTELEPHONE:
(510) 797-2222
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:53CENSUS: 16DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ruby MasihTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Record Keeping
INVESTIGATION FINDINGS:
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On 12/12/2023, Licensing Program Analysts (LPAs) Jaleesa Jackson and Manel Estoesta met with Director Ruby Masih to deliver the finding of an complaint filed against Nurturekids Montessori, Preschool & Extended Care regarding the allegation of record keeping. Present during the inspection was 2 staff and 16 preschool aged children.

The allegation the facility is not providing copies of the admission agreement has been SUBSTANTIATED. Based on LPA's interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22, Division 12, Chapter 1, Section 101219(e) is being cited on the attached LIC 9099D.

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

Appeal Rights were given and discussed. An exit interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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 2
Control Number 52-CC-20231108153107
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: NURTUREKIDS MONTESSORI, PRESCHOOL & EXTENDED CARE
FACILITY NUMBER: 013413922
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/09/2024
Section Cited
CCR
101219(e)
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(e)The licensee shall keep the original copy of the admission agreement and give a photocopy to the child's authorized representative.
This requirement was not met as evidenced by
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An addendum needs to be added to the parent handbook listing that copies of documents (admission agreement, parental rights, and personal rights) will be provide to parents at admission. Currently enrolled authorized representatives are to be provided copies of their current admission agreement.
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Based on interview, copies of the admission agreement were not provided to authorized representatives which poses a potential health and safety risk to children in care.
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Director will provide proof of parent receipt of admission agreement and a copy of the addendum to LPA by email by POC date.
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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: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2