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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408259
Report Date: 11/03/2022
Date Signed: 11/03/2022 03:57:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2022 and conducted by Evaluator Phyllis Dyer
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220815135021

FACILITY NAME:CREATIVE MONTESSORI PRESCHOOLFACILITY NUMBER:
073408259
ADMINISTRATOR:AKTER, SILVIAFACILITY TYPE:
830
ADDRESS:1350 MORAGA WAYTELEPHONE:
(925) 377-8314
CITY:MORAGASTATE: CAZIP CODE:
94556
CAPACITY:14CENSUS: 8DATE:
11/03/2022
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Silvia AkterTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Personal Rights - Hazardous items in reach of children.
INVESTIGATION FINDINGS:
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LPA Dyer conducted an unannounced complaint inspection to deliver the findings of the above allegation. LPA met with director Silvia Akter. Present at the facility: the director, 1 infant assistant, and 8 preschool children.
It was alleged that there were Hazardous items in reach of children.
During the course of the investigation, interviews were conducted and a tour of the facility was completed. LPA observed an gate leading to the kitchen was open. Bleach and other dangerous items were located under the kitchen sink. Cord for CD will also need to be removed out of reach of children.
Based on the LPA's observations and interviews which were conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, (Title 22, Division 12), are being cited on the attached LIC 9099D and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report 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. All parents/guardians must sign an Acknowledgement Form of proof of receiving this
(continued)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 02-CC-20220815135021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CREATIVE MONTESSORI PRESCHOOL
FACILITY NUMBER: 073408259
VISIT DATE: 11/03/2022
NARRATIVE
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report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing. Exit interview conducted. Appeal rights were discussed and given. Notice of Site visit must be posted for 30 days.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 02-CC-20220815135021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CREATIVE MONTESSORI PRESCHOOL
FACILITY NUMBER: 073408259
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2022
Section Cited
CCR
101238(g)(1)
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101238 Buildings and Grounds. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
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Director closed gate and moved cord; and stated gate will remain closed and cord be kept out of reach of children.
CLEARED DURING INSPECTION.
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This requirement was not met as evidenced by observation: LPA observed an open gate to the kitchen and bleach in an unlocked cabinet; and a CD cord accessible. This was pointed out to the director. This poses a potential health risk to the health and safety of children in care.
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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.
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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.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6