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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414800
Report Date: 03/14/2023
Date Signed: 03/14/2023 12:49:17 PM

Document Has Been Signed on 03/14/2023 12:49 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: 25DATE:
03/14/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Cindy AckerTIME COMPLETED:
01:00 PM
NARRATIVE
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On 3/14/23, at 9:39AM, Licensing Program Analyst (LPA) Catherine Fernandes arrived unannounced on case management inspection and met with Justin Rivers shortly after owner Cindy Acker arrived. Present in care were 25 preschoolers and an additional five staff members.

At 9:39am LPA observed staff member Jasmin Zafra (JZ) in the art classroom providing care to the children. LPA reviewed the center's fingerprint clearances and observed JZ has a pending clearance. Cindy Acker confirmed that JZ has been working at the center since February 24th, 2023 and thought she was cleared.

During an investigation it was revealed that Brionna Acker was present in the center and around the children in care in 2022 without a clearance.

LPA Fernandes informed licensee Acker that this report dated 3/14/23 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate safety risk to children in care.

Also, LPA informed licensee Acker to provide a copy of this licensing report dated 3/14/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A civil penalty has been issued see LIC9213.

Exit interview conducted.

Notice of site visit, Report, Appeal Rights, and LIC 9444 has been provided.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023
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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Document Has Been Signed on 03/14/2023 12:49 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 03/14/2023 at 11:15 AM
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: 03/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/15/2023
Section Cited
CCR
101170(e)1

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1)Obtain a California clearance or a criminal record exemption as required by the Department. This requirement has not been met as evidenced by:
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Center will remove unfingerprinted staff immediately, then review criminal record clearance regulations. Then send a statement of understanding to CCL by proof of correction date.
A civil penalty of $1,000 has been assessed.
* Jasmin Zafra was dismissed while LPA was at the center.
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Based on interviews and records Brionna Acker and Jasmin Zafra have been in the center with the children in care without a criminal record clearance, which poses an immediate danger to 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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


LIC809 (FAS) - (06/04)
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