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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420975
Report Date: 11/01/2022
Date Signed: 11/01/2022 04:03:56 PM

Document Has Been Signed on 11/01/2022 04:03 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:ACADEMIA DE MI ABUELAFACILITY NUMBER:
013420975
ADMINISTRATOR:REIMANN, CYNTHIAFACILITY TYPE:
850
ADDRESS:2162 MOUNTAIN BLVD STE 300TELEPHONE:
(510) 336-7082
CITY:OAKLANDSTATE: CAZIP CODE:
94611
CAPACITY: 53TOTAL ENROLLED CHILDREN: 53CENSUS: DATE:
11/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Cynthia ReimannTIME COMPLETED:
04:30 PM
NARRATIVE
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On 11/1/22, at 10:45AM , Licensing Program Analysts (LPAs) Catherine Fernandes and Indira Loza conducted a case management investigation and met with Assistant Director Yaneldis Diaz. Towards the end of the inspection Director Cynthia Reimann arrived. Present in care were 28 preschoolers, five teachers and one assistant. During the inspection LPAs did a walk through of the center and obtained child's roster.

While at the center LPAs observed feces left in the urinal that was put there by a child after using a potty chair. Assistant Director Diaz stated that they are teaching children the full process of potty training from using the potty to disposing of the waste in the toilet and washing hands.

Title 22 is being cited on the attached LIC. 9099D.

Exit interview conducted with Director Reimann
Appeal Rights, Report, and Notice of site visit provided.



SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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 11/01/2022 04:03 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 11/01/2022 at 02:50 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: ACADEMIA DE MI ABUELA
FACILITY NUMBER: 013420975

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2022
Section Cited
CCR
101239(f)

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Fixtures, Furniture, Equipment and Supplies: Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors.... This requirement has not been met as evidenced by:
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Licensee will come up with a new potty system that ensures the waste is correctly disposed and cleaned. Director shall send the plan to CCL by POC date.
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Based on observations and interview, children are disposing of their own waste and feces was left in a urinal, which is a potential safety risk for 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 Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022


LIC809 (FAS) - (06/04)
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