013418992-6-28-2023-02-CC-MMAW-CT8RLF-20230628130704

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418992
Report Date: 06/28/2023
Date Signed: 06/28/2023 01:07:09 PM

Document Has Been Signed on 06/28/2023 01:07 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	CEDAR CREEK MONTESSORI SCHOOL		FACILITY NUMBER:	013418992
ADMINISTRATOR:	OFFRIL, PRIMA		FACILITY TYPE:	850
ADDRESS:	1600 SACRAMENTO ST.		TELEPHONE:	(510) 525-1377
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	40	CENSUS: 30	DATE:	06/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:06 AM
MET WITH:	Prima Offril		TIME COMPLETED:	01:20 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 6/28/23 at 10:33 AM, Licensing Program Analyst (LPA) Michael Mathew conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with director Prima Offril and advised her the purpose of the inspection. LPA was provided a tour of the facility inside and out. There were 30 children in care and 8 staff at the time of the inspection. LPA observed required licensing documents mounted on the walls throughout the facility. Director stated that facility does provide snack in an emergency, snacks and Lunch is brought from the child's home. Fire drill was last conducted on 5/10/23. The center has two (2) classrooms available. At the time of inspection, all classrooms were in use. LPA observed enough restrooms available for children in care. LPA did not observe any hazards/toxins items accessible to children in care. There are no guns/weapons or ammunition at the facility. LPA observed no bodies of water. Each of the classrooms have age-appropriate toys and furniture readily accessible for children. Facility provides children sleeping mats during nap time. Fire alarm and carbon monoxide detector are good and in working condition. The outdoor playground has ample amount of space for children to play. LPA observed tan bark under the play structure to help protect the children when they fall. LPA observed the playground has age-appropriate toys and structures available for children to use. The playground has an ample amount of shade available. Facility provides water, and the children have water bottles with their names on it for use. A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. Currently the facility does have children that require Incidental Medical services (IMS). LPA observed staff files to be incomplete. LPA observed three staff members without a LIC 503 Form (Health screening Form). LPA observed all staff members with a valid mandated reporter certificate and CPR/first aid certificate. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. LPA spoke with director about new Covid-19 guidelines. Facility is currently following Covid-19 guidelines. Continued 809-C

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael Mathew	TELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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 06/28/2023 01:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CEDAR CREEK MONTESSORI SCHOOL	FACILITY NUMBER: 013418992
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. Director stated that director might have missed placed LIC 503 Health screening form while reviewing staff and did not follow-up with staff to get LIC 503 form completed.
	POC Due Date: 07/13/2023
	Plan of Correction
1 2 3 4	DIrector agreed to sent completed LIC503 form to LPA via email by end of day Thursday 7/13/23.

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	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael Mathew	TELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CEDAR CREEK MONTESSORI SCHOOL	FACILITY NUMBER: 013418992
	VISIT DATE: 06/28/2023

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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-carecenters/

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Director Prima was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated

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

1 Type B deficiency was cited in today visit.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights were given, and report was reviewed with director Prima

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael Mathew	TELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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