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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420975
Report Date: 12/01/2022
Date Signed: 12/01/2022 12:37:11 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/01/2022 12:37 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:
12/01/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Cynthia ReimannTIME COMPLETED:
01:15 PM
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On December 1, 2022 at 9:06am Licensing Program Analysts (LPAs) Indira Loza and Catherine Fernandes met with Director Cynthia Reimann for an Annual Continuation. There were 26 preschool age children and five fingerprint cleared staff. The teacher/child ratio was being met today. The center was toured for a health and safety inspection. The facility operates from 7:30am – 5:30pm Monday through Friday.

The preschool operates out of three classrooms and an open activity space. There are three toilets and three sinks. All sinks and toilets are observed to be clean and in proper working order. The facility has age appropriate materials in all classrooms that are observed to be clean and in good condition. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. For drinking water indoors and outdoors, children have individual water bottles. Each classroom has a fully charged fire extinguisher. The fire system is hard wired. There is a working carbon monoxide detector in the lobby. The outdoor play area is clean with ample age appropriate materials for the children, there is also a tree house seating area to read books. The center has a waiver for the playground allowing 41 children at a time. The yard is fully fenced in and has plenty of shade for the children. LPA did not observe any harmful or unattended bodies of water in or around the facility. The isolation area will be in the lobby.

The facility is operating within its licensed capacity and is in ratio. All proper postings are made visible. The school does not provide any meals or snacks for the children. In the event a child forgets a meal or snack, or does not have enough, the facility will provide a small snack and inform the parent/guardian right away. The fire/disaster drill log was complete with the last drill logged 9/2022. A physical census of the children and staff were taken and cross referenced with the electronic sign-in and out log. All children were accounted for and properly signed in. All staff have obtained a criminal record clearance. LPAs reviewed all of the current staff records and seven children's files. All files were complete and current.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six
************Report Continues on 809-C***********
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ACADEMIA DE MI ABUELA
FACILITY NUMBER: 013420975
VISIT DATE: 12/01/2022
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(6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone or fax. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

This facility provides Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The center is providing IMS and has the proper documentation for the child.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
************Report Continues on 809-C************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
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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: ACADEMIA DE MI ABUELA
FACILITY NUMBER: 013420975
VISIT DATE: 12/01/2022
NARRATIVE
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The following Type B citations were issued:

- Garbage bins missing tight fitting lids
- Staff Immunizations
- Mandated Reporter Training
- Health and Safety training
- Staff Health Screening
- Criminal Record Statements (LIC 508)
- Physician Reports
- Children immunization
- Personal Rights (LIC 613A)
- Parent Medication Authorization (LIC 9221)
- Parent's Rights (LIC 995)
- Children ID (LIC 700)

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Director Cynthia Reimann.
Report and appeal rights provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
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Document Has Been Signed on 12/01/2022 12:37 PM - It Cannot Be Edited


Created By: Indira Loza On 12/01/2022 at 10:31 AM
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: 12/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited
CCR
101218.1(e)(1)

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The licensee shall request the child’s parent or authorized representative to sign and date the acknowledgement-of-receipt statement at the bottom of the LIC 995 (8/02). The bottom portion of this form must be kept in the child's file as proof that the parent or authorized representative has been notified
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Director shall review the regulation and email LPA the signed LIC 995 that were missing from the files, no later than December 16, 2022.
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of his or her rights by the child care center... This requirement was not met as evidenced by: Based on file reviews it was discovered the form was missing in the children's fiiles.
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Type B
12/16/2022
Section Cited
CCR101238

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(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by: Based on observation the temperature in the facility was very cold, and there was not a working
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Director shall review the regulation and have a working thermostat installed in the facility. The Director shall email pictures of the working thermostat to the LPA no later than December 16, 2022.
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 thermostat to track the temperature in the facility.
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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:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022


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