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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420947
Report Date: 11/29/2023
Date Signed: 11/29/2023 02:06:51 PM


Document Has Been Signed on 11/29/2023 02:06 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:CHILD UNIQUE MONTESSORI SCHOOL, THEFACILITY NUMBER:
013420947
ADMINISTRATOR:ACKER, CINDYFACILITY TYPE:
850
ADDRESS:1400 - 6TH STTELEPHONE:
(510) 521-0595
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:75CENSUS: 20DATE:
11/29/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:TIME COMPLETED:
02:15 PM
NARRATIVE
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On 11/15/23 at 11:12am, Licensing Program Analyst (LPA) Catherine Fernandes arrived unannounced on case management inspection regarding a self reported incident that was provided to the Oakland Community Care Licensing office. LPA Fernandes met with owner Cindy Acker and explained the purpose of the visit. Present during the visit was 20 preschoolers and four additional staff members.

There was an incident that occurred on 11/13/23 involving a preschool teacher grabbing a child to stop the child for running in the classroom. The day of the incident the teacher was immediately sent home and has not returned to the center since the incident. LPA Fernandes conducted interviews, collected documents pertaining to the incident and based on the information obtained a child's personal rights were violated resulting in a Type A citation. The citation was cleared during the visit, LPA Fernandes was given dates by Cindy Acker for the scheduled training that was planned prior to the citation.

LPA Fernandes informed owner Cindy Acker that this report dated 11/29/23 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the personal rights of children in care. Also, LPA Fernandes informed the Acker to provide a copy of this licensing report dated 11/29/23 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
Exit interview conducted with Director Cindy Acker

Report, Appeal Rights and Notice of site visit provided.



See 809D for citation
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
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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Document Has Been Signed on 11/29/2023 02:06 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: CHILD UNIQUE MONTESSORI SCHOOL, THE
FACILITY NUMBER: 013420947

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/30/2023
Section Cited
CCR
101223(a)(2)

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The licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement was not met as evidenced by:
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The center will come up a date for a staff training regarding the personal rights of children and come with a list of ways staff members can handle difficult situations. Then submit the date of the training to CCL by POC date.
* training scheduled for 12/1/23 & 12/4/23*
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Based on interviews a child was grabbed by a teacher which is an immediate risk to the personal rights of children in care.
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 Cleared during visit

After the training the center is to send the staff responses to LPA Catherine Fernandes.

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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: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
LIC809 (FAS) - (06/04)
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