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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414800
Report Date: 02/23/2023
Date Signed: 02/23/2023 01:06:02 PM

Document Has Been Signed on 02/23/2023 01:06 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CHILD UNIQUE MONTESSORI SCHOOL, THEFACILITY NUMBER:
013414800
ADMINISTRATOR:NILES, JOSEPHFACILITY TYPE:
850
ADDRESS:2226 ENCINAL AVENUETELEPHONE:
(510) 521-9227
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 24DATE:
02/23/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cindy AckerTIME COMPLETED:
01:15 PM
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On 2/23/2023 at 10:00am, Licensing Program Analyst (LPA) Catherine Fernandes met with owner Cindy Acker for a case management- annual continuation inspection. There were 24 preschool age children in care and an additional six finger print cleared staff members. The teacher- child ratio was being met today. The center was toured for a health and safety inspection. The facility operates from Monday through Friday from 7:00am–6:00pm.

The center operates out of a converted two story house, and utilizes only the first floor for the day care children. There are two main classrooms and a third room that is used as an art classroom. The entrance to the center is on the left side of the house. The room floors, surfaces, furniture and equipment appear to be safe, sanitary and in good repair. The heating, lighting and ventilation is adequate. There is a total of three toilets, and four sinks available for the children which are sanitary and in operational conditions. There are supplies available for the children to wash and dry their hands. There is a separate bathroom for staff located in the four room which is off limits for children in care. The activities and toys appear to be age appropriate. The outside play area is fully fenced with shaded areas for the children. There is play structure that is sturdy and anchored into the ground, there are wood chips for cushioning to absorb the impact from a fall. LPA did not observe any bodies of water, free standing water, cleaning supplies, or toxic items accessible to children during today’s inspection. The center provides snacks to the children while in care and lunches are brought from home. There is a current snack menu posted for the week. The children have their own cubbies and hooks to store personal belongings. The children have personal water bottles in the classroom and when children are playing in the yard children will bring their water bottles outside. The center also has a supply of paper cups if water bottle are forgotten. The center has scheduled their lead testing for next month. The fire system is hardwired. There is a working carbon monoxide detector and a fully charged fire extinguisher. The center's smoke detector was tested and is working. The fire/disaster drill log was complete with the last drill logged December 2022.



All proper postings are made visible by the front of the center’s entrance. LPA reviewed 10 children’s files and all staff members. LPA obtained a copy of the children’s roster and an updated Personnel report.
Report continued on 809C
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CHILD UNIQUE MONTESSORI SCHOOL, THE
FACILITY NUMBER: 013414800
VISIT DATE: 02/23/2023
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The following deficiency was observed at 11:37am, physical census of the children was taken and cross referenced with the electronic sign-in and out log. There were 24 children in care and only 11 children were signed in.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Incidental Medical Services, NO IMS is being provided as of today’s date. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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

See 809D for the deficiency cited during today's inspection.


Exit interview conducted and reviewed with owner Cindy Acker
Report and Appeal Rights provided
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
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Document Has Been Signed on 02/23/2023 01:06 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 02/23/2023 at 12:10 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CHILD UNIQUE MONTESSORI SCHOOL, THE
FACILITY NUMBER: 013414800

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out- The person who brings the child to, and removes the child from, the center shall sign the child in/out.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above only 11 children out of 24 were signed for the day which poses a potential safety risk to persons in care.
POC Due Date: 03/01/2023
Plan of Correction
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The center will review the sign in and sign out regulations, then come up with a plan to ensure all present children are properly reflected with sign and sign out procedures. By proof of correction date the center will send the plan to CCLD.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023


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