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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419485
Report Date: 01/29/2021
Date Signed: 01/29/2021 05:09:57 PM

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:TUDORKA TOTS INFANT AND PRESCHOOL CENTERFACILITY NUMBER:
013419485
ADMINISTRATOR:ZIMANY, RENATAFACILITY TYPE:
830
ADDRESS:12000 CAMPUS DRIVETELEPHONE:
(510) 531-2223
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:28CENSUS: 9DATE:
01/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Renata ZimanyTIME COMPLETED:
05:00 PM
NARRATIVE
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On January 29, 2021 at 2:14PM, Licensing Program Analyst (LPA) Catherine Fernandes and Licensing Program Manager (LPM) Mayla Mendoza conducted an unannounced case management inspection with Licensee Renata Zimany. Present during the inspection was four staff members and nine infants.

During the walk through Licensee Zimany confirmed that she was unaware that she had to provide parents with the complaint report and type A citation from January 15, 2021. Licensee was to have parents sign off on form LIC 9224 as proof that parents received the report.


See 809-D for deficiency cited today.
A notice of site visit was given and must remain posted for 30 days.
Report, Appeal rights and LIC9224 Emailed.
Exit interview conducted

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021
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: TUDORKA TOTS INFANT AND PRESCHOOL CENTER
FACILITY NUMBER: 013419485
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/19/2021
Section Cited

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Health and Safety Code Section 1596.8595(c) A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of
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subdivision (a) of Section 1596.893b. This requirement has not been met as evidenced by: Based on conformation from the Licensee the report was not provided to the parents and parents did not sign off on the LIC 9224, which can pose a potential health and safety risk to children in care.
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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: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2021
LIC809 (FAS) - (06/04)
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