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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408260
Report Date: 02/25/2025
Date Signed: 02/26/2025 09:46:24 AM

Document Has Been Signed on 02/26/2025 09:46 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CREATIVE MONTESSORI PRESCHOOLFACILITY NUMBER:
073408260
ADMINISTRATOR/
DIRECTOR:		AKTER, SILVIAFACILITY TYPE:
850
ADDRESS:1350 MORAGA WAYTELEPHONE:
(925) 377-8314
CITY:MORAGASTATE: CAZIP CODE:
94556
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 5DATE:
02/25/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:SILVIA AKTERTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 2/25/2025 Licensing Program Analyst (LPA) Tasha Alexander met with center director Silvia Akter to deliver the findings to complaint allegations. During this analyst's investigation it was discovered that in August 2024 a child suffered a medical condition which required CPR. The facility failed to report the incident to Community care licensing as required by California Title 22 regulations.

See the attached 809-d for citation

An exit interview was conducted with center director Silvia Akter
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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 02/26/2025 09:46 AM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 02/25/2025 at 04:02 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CREATIVE MONTESSORI PRESCHOOL
FACILITY NUMBER: 073408260

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/11/2025
Section Cited
CCR
101212(d)(2)

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101212 Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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(2) Information provided shall include the following:

(A) Child's name, age, sex and date of admission.

(B) Date and nature of event.

(C) Attending physician's name, findings, and treatment, if any.

(D) Disposition of the case.

THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY RECORD REVIEWS AND INTERVIEWS WHICH REVEALED THE FACILITY FAILED TO REPORT TO COMMUNITY CARE LICENSING, AN INCIDENT THAT OCCURED IN AUG 2024 WHEN A CHILD SUFFERED A MEDICAL EMERGENCY THAT REQUIRED CPR.
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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:Monica Mathur
LICENSING EVALUATOR NAME:Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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