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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408259
Report Date: 06/29/2023
Date Signed: 06/29/2023 12:45:19 PM

Document Has Been Signed on 06/29/2023 12:45 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:CREATIVE MONTESSORI PRESCHOOLFACILITY NUMBER:
073408259
ADMINISTRATOR:AKTER, SILVIAFACILITY TYPE:
830
ADDRESS:1350 MORAGA WAYTELEPHONE:
(925) 377-8314
CITY:MORAGASTATE: CAZIP CODE:
94556
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 2DATE:
06/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Silvia AkterTIME COMPLETED:
01:30 PM
NARRATIVE
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On 06/29/2023 at 9:30AM Licensing Program Analyst (LPA), A. Curry conducted an unannounced required inspection. LPA met with the director, Silvia Akter, to explain the purpose of today's visit. This is an infant program licensed for 14 children. This facility operates Monday – Friday from 8:00 AM – 5:00 PM. Per the director there are 3 children enrolled. This is a combination center with preschool license on site, License # 073408260.

LPA A. Curry began facility tour and all areas identified on the facility sketch were inspected. Upon arrival, LPA observed 2 infants with 1 Aid (See 809D). Teacher-infant ratios were not observed to be in accordance with Title 22 regulations. The director contacted a fully qualified teacher, who came in during the visit.Staff names were recorded. Classrooms were observed to ensure that infants are never left unattended and under the direct visual supervision of a staff person at all times.

The facility was inspected to ensure that it is clean, safe, sanitary, and in good repair to ensure the safety and well being of children, employees and staff. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. The facility has age appropriate furniture and equipment including but not limited to cribs, cots/mats and changing tables. LPA observed that infant changing tables are within an arm’s reach of a sink. LPA observed sufficient infant napping equipment that meets the requirements of Title 22 regulations. LPA did not observe any baby walkers or any items that fall into that category present in the facility. At this time, the office is used as an isolation area. Parents are contacted immediately when children are determined to be ill.

The facility does not provide any meals for infants. All food is provided by parents. LPA observed that bottles, dishes, and containers of food brought by the infant’s authorized representatives were not labeled with the infant’s name and current date (See 809D). Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to infants. LPA advised director that storage areas for poisons need to be kept locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The Administrator takes measures to keep the facility free of flies, other insects and rodents.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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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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: CREATIVE MONTESSORI PRESCHOOL
FACILITY NUMBER: 073408259
VISIT DATE: 06/29/2023
NARRATIVE
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Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface was not maintained in a safe condition as is not free of hazards (See 809D). The wooden outside fence area is damaged with a hole in it and the broken wood pieces are are the ground accessible to children in care. The director indicated she will not use that area until it is fixed. LPA did not observe any bodies of water during this visit.

Sign in and out sheets were reviewed to ensure that children present are signed in. Staff Records were reviewed to ensure that personnel records are maintained on all staff. Also to ensure that Teacher’s present have required infant units on file and are qualified. Children’s Records were reviewed to ensure that each child has a separate, complete, and current record, a Needs and Services Plan, and a medical assessment are on file. LPA issued the Children’s Record Review (LIC 857) and the Review of Staff records (LIC 859) to the Administrator during this inspection. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed.



LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/. PIN 22-05-CCP

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/29/2023 12:45 PM - It Cannot Be Edited


Created By: Ashley Curry On 06/29/2023 at 11:36 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: CREATIVE MONTESSORI PRESCHOOL
FACILITY NUMBER: 073408259

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above by ensuring there is not a big hole in the wooden fence and wooden pieces on the ground that are accessible to children in care, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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By 07/03/2023 submit a picture of the area showing the wooden pieces from the fence are picked up and made inaccesibble to children.

By07/21/2023 submit a written plan of when the fence will be repaired.
Type B
Section Cited
CCR
101416.3(b)
Infant Care Aide Teacher Qualifications and Duties
(b) An infant care aide shall work under the direct supervision of the director, the assistant director or a fully qualified teacher, except as provided for in Section 101416.5(d)(1).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above by ensuring there is a fully qualified teacher in the classroom with infants, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2023
Plan of Correction
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By 07/14/2023 submit a written plan on how you will comply with the section cited above.
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:Loretta Dyson
LICENSING EVALUATOR NAME:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/29/2023 12:45 PM - It Cannot Be Edited


Created By: Ashley Curry On 06/29/2023 at 11:36 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: CREATIVE MONTESSORI PRESCHOOL
FACILITY NUMBER: 073408259

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101427(j)
Infant Care Food Service
(j) Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring all infant's bottles and containers are labeled with the infant's name and current date, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2023
Plan of Correction
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By 07/14/2023 please notify all infant's families in writing that all bottles, dishes, and containers must be labeled with infant's name and the current date. Send LPA a copy of the notification that was sent to families.
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:Loretta Dyson
LICENSING EVALUATOR NAME:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023


LIC809 (FAS) - (06/04)
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