013422068-3-1-2023-52-CC-JSAI-CPHQYF-20230301113503

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422068
Report Date: 03/01/2023
Date Signed: 03/01/2023 11:35:31 AM

Document Has Been Signed on 03/01/2023 11:35 AM - 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: 20	DATE:	03/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Director, Grace Sayo		TIME COMPLETED:	12:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Jyoti Saini met with director Grace Soyo for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the director. In addition to the director, there are 20 children and two staff present today. The facility operates Monday - Friday from 8:30 AM to 6:00 PM out of the Tulip and Lilly classrooms and the lobby area as needed. The facility was inspected indoor and outdoor today for health and safety hazards and the following was observed:

There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. A first aid kit and a first aid backpack are available. The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition. There is one bathroom with 3 toilets and 1 sink. The staff has separate bathroom. The bathrooms appear to be safe, sanitary, and free of any hazardous items. There is drinking water readily available for children. The facility provides lunch and snacks and menu is posted. LPA reviewed storage of food and reminded facility representative that all food must be in original packaging or labeled with expiration date. The classroom has appropriate postings. The last Emergency Drill was conducted on 01/31/2023 and is properly logged.

LPA reviewed sign-in and out sheet. There is a working fire alarm system in the facility. The Facility has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available. All the Children records reviewed were complete. All children have a record of emergency identification information on file. All staff has a criminal record clearance on file. The site Director has a current Pediatric First Aid/CPR certificate on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site always or present during off-site activities (field trips). Facility roster was reviewed, and copy was obtained.

See next page..

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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 03/01/2023 11:35 AM - It Cannot Be Edited

Created By: Jyoti Saini On 03/01/2023 at 10:53 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: NURTURE KIDS MONTESSORI	FACILITY NUMBER: 013422068
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as two staff members does not have proof of Measles (MMR) immunization which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/22/2023
	Plan of Correction
1 2 3 4	Director shall submit MMR immunization for both the staff members to CCLD by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Jyoti Saini

LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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: 03/01/2023

NARRATIVE

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During inspection,

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.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children currently. If any IMS is provided, a Plan for Providing 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.

The attached (LIC809-D) Type B deficiency was cited today.

Two Technical Violations were also given during the inspection, please see LIC 9102 for Technical Violations.

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, Garce Soyo

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC809 (FAS) - (06/04)

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