<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013413922
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:42:47 PM

Document Has Been Signed on 12/12/2023 04:42 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: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: 53TOTAL ENROLLED CHILDREN: 42CENSUS: 16DATE:
12/12/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ruby ManishTIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/12/2023 LPAs Jaleesa Jackson and Manel Estoesta conducted a case management visit. LPAs met with Director Ruby Masih. Present for the inspection was 2 staff and 16 preschool age children in care.

LPAs discovered copies of licensing reports dated 6/29/23, 9/28/23, and 10/02/23, were not given to parents/authorized representatives along with each LIC 9224 prior to enrollment based on Directors statement and review of enrollment documents.

Director was informed of this on report dated 9/28/23 that provide copies to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports should be signed by guardians and placed in each child’s file.

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

Exit interview conducted with Ruby Manish and appeal rights provided.
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.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/12/2023 04:42 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 12/12/2023 at 03:50 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: 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
HSC
1596.8595(c)(2)

1
2
3
4
5
6
7
(c)(2)Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing report that the licensee has received during the prior 12-month period that documents any Type A citation...
1
2
3
4
5
6
7
An addendum needs to be added to the parent handbook listing that copies of licensing reports of type A violations will be provide to parents upon enrollment.
8
9
10
11
12
13
14
This requirement was not met as evidenced by:
Based on interview and record review, copies of licensing reports were not provided to parents at enrollment which poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
Currently enrolled parents or authorized representatives are to be provided copies of the licensing reports from 6/29/23, 9/28/23, and 10/2/23.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 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


LIC809 (FAS) - (06/04)
Page: 2 of 2