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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418197
Report Date: 06/25/2024
Date Signed: 06/25/2024 02:21:05 PM

Document Has Been Signed on 06/25/2024 02:21 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LITTLE FLOWERS MONTESSORI, INCFACILITY NUMBER:
013418197
ADMINISTRATOR/
DIRECTOR:		MAGGIE BALTAZARFACILITY TYPE:
850
ADDRESS:34735 ARDENWOOD BLVD.TELEPHONE:
(510) 793-1696
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 217TOTAL ENROLLED CHILDREN: 217CENSUS: 189DATE:
06/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Maggie BalthazarTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
NARRATIVE
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On 6/25/2024 at 10:20AM, Licensing Program Analyst (LPA) Jaleesa Jackson conducted a Case Management visit following an Unusual incident that occurred on 6/5/24. Present for the inspection were 21 staff, 180 preschool age children, and 9 toddlers. Director self reported the incident on 6/6/24. LPA conducted a staff interview and record review.

LPA Jackson spoke with the facility Director Maggie Balthazar about the incident that happened on 6/5/24.
C1 was crying in the classroom and S1 tried to pick up the child to sooth them. S1 grabbed C1 to pick them up. C1 did not want to be picked up and resisted. The incident resulted in visible red marking underneath the child's arms.

There is 1 deficiency being cited today. See 809-D for deficiency.

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

Exit interview conducted and report was reviewed with Director Maggie Balthazar.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 06/25/2024 02:21 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 06/25/2024 at 01:15 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: LITTLE FLOWERS MONTESSORI, INC
FACILITY NUMBER: 013418197

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2024
Section Cited

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 The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons.
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This requirement was not met as evidenced by:
Based on interview and record review S1 grabbed and picked up C1 while C1 resisted resulted in visible marks under C1's underarms which posed a potential risk to the health, safety, or personal rights to persons 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:Jason Jang
LICENSING EVALUATOR NAME:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/25/2024


LIC809 (FAS) - (06/04)
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