013422068-5-6-2022-52-CC-JMIR-CE6RHU-20220506130255

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422068
Report Date: 05/06/2022
Date Signed: 05/06/2022 01:03:11 PM

Document Has Been Signed on 05/06/2022 01:03 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	NURTURE KIDS MONTESSORI		FACILITY NUMBER:	013422068
ADMINISTRATOR:	SAYO, GRACE		FACILITY TYPE:	850
ADDRESS:	6837 AMADOR VALLEY BLVD.		TELEPHONE:	(925) 803-5867
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY: 36	TOTAL ENROLLED CHILDREN: 36	CENSUS: 14	DATE:	05/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Seema Vaishnav		TIME COMPLETED:	01:15 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 05/06/2022 Licensing Program Analyst (LPA) Jaylena Miller conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION. LPA met with Seema Vaishnav Lead Teacher while Director is out, also present at the time of this inspection were 2 staff and 14 children. The facility is within ratio and capacity compliance today. LPA provided facility representative the form LIC 125 via email. The facility was toured to conduct a Health and Safety Inspection. This program current operates Monday-Friday from 8:30am-6:00pm out of the Tulip and Lilly classrooms and the lobby area as needed. All classrooms were inspected for age appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces, the presence of working carbon monoxide detector, smoke detectors/fire alarms and a fully charged fire extinguishers size 3A-40-BC that is accessible throughout the facility. The bathrooms have age appropriate faucets and toilets in working condition. The outdoor play area is fully fenced. There is padding under/around the climbing equipment. LPA observed the play structures to be fully intact with no visual defects or concerns. There are no pools, hot tubs or other accessible bodies of water. Per facility representative, there are no firearms present on the premises. Cleaning supplies/toxins are stored inaccessible to children during the inspection and all required postings are present. The facility serves lunch and am/pm snacks, menu is also posted. LPA reviewed storage of food and reminded facility representative that all food must be in original packaging or labeled with expiration date. The center also conducts and documents fire and earthquake drills once every 6 months and the logs show that drills were conducted on 3/14/2022. A copy of the facility personnel roster and children’s roster were available for review and copy was obtained. LPA reviewed the file of 11 children enrolled in the program and 3 staff members files, who are fingerprint cleared, completion of Mandated Reporter training which was expired please see LIC 809-D for deficiency. No proof of immunizations for two staff please see LIC 9102 for technical violation. The opening and closing staff have current CPR/First Aid certificates that are current, and proof of education and/or experience was also present. Staff interview also conducted and documented. Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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 05/06/2022 01:03 PM - It Cannot Be Edited

Created By: Jaylena Miller On 05/06/2022 at 12:04 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: NURTURE KIDS MONTESSORI	FACILITY NUMBER: 013422068
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(a)

Child's Medical Assessments

(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records reviewed, the facility did not comply with the section cited above in 5 out of 11 children whose files were inspected are missing physcians reports (LIC 503) from their file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/06/2022
	Plan of Correction
1 2 3 4	Facility representative will give each childs parent who is missing the LIC 503 30 days to complete the form or the child can not return to care until the form is completed and in the child's file. Facility representative will use LIC 125 as a guide and conduct a comprehensive check on all children's files. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

Type B

Section Cited

CCR

101223(b)(1)

Personal Rights

(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records reviewed, the licensee did not comply with the section cited above in 7 out of 11 children whose files were inspected are missing personal rights form (LIC 613A) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/06/2022
	Plan of Correction
1 2 3 4	Facility representative will give each childs parent who is missing the LIC 613A a copy and have the parent complete the form within 30 days or the child can not return to care until form is compeleted and in the file. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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:

Wynn Norona

LICENSING EVALUATOR NAME:

Jaylena Miller

LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC809 (FAS) - (06/04)

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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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: NURTURE KIDS MONTESSORI	FACILITY NUMBER: 013422068
	VISIT DATE: 05/06/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

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.

Facility representative 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.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Facility representative was reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Facility representative was reminded of the responsibility as a mandated reporter and the training's must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged facility representative to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC809 (FAS) - (06/04)

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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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: NURTURE KIDS MONTESSORI	FACILITY NUMBER: 013422068
	VISIT DATE: 05/06/2022

NARRATIVE

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Effective August 1, 2003 California Law requires Child Care licensees 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 to the regional office by phone and the written report, LIC 624 within 7 business days.

After a complete inspection of the facility, the attached Type B deficiencies were cited, please see LIC 809-D for deficiencies cited. Three Technical Violations were also given during the inspection, please see LIC 9102 for Technical Violations cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Seema Vaishnav.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC809 (FAS) - (06/04)

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