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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
013420975
Report Date:
11/17/2022
Date Signed:
11/17/2022 04:54:40 PM
Document Has Been Signed on
11/17/2022 04:54 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 ABUELA
FACILITY NUMBER:
013420975
ADMINISTRATOR:
REIMANN, CYNTHIA
FACILITY TYPE:
850
ADDRESS:
2162 MOUNTAIN BLVD STE 300
TELEPHONE:
(510) 336-7082
CITY:
OAKLAND
STATE:
CA
ZIP CODE:
94611
CAPACITY:
53
TOTAL ENROLLED CHILDREN:
53
CENSUS:
DATE:
11/17/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:32 AM
MET WITH:
Cynthia Reimann
TIME COMPLETED:
04:59 PM
NARRATIVE
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On 11/16/22 at 9:32AM, Licensing Program Analysts (LPAs) Indira Loza and Catherine Fernandes met with Director Cynthia Reinmann for an
Unannounced Required Annual Inspection
. There were 23 preschool age children and five additional fingerprint cleared teachers. 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.
Due to time constraints the annual inspection will be continued at a later date.
Deficiencies were reviewed with Licensee. Licensee confirmed she understands the Proof of Corrections.
Exit Interview conducted with Licensee.
Appeal Rights, Notice of Site visit, and report provided to Licensee/Director Cynthia Reimann.
SUPERVISORS NAME
:
Mayla Mendoza
LICENSING EVALUATOR NAME
:
Indira Loza
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/17/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/17/2022
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
7
Document Has Been Signed on
11/17/2022 04:54 PM
- It Cannot Be Edited
Created By:
Indira Loza
On
11/17/2022
at
03:25 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:
11/17/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(f)(1)
Fixtures, Furniture, Equipment and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observations, the licensee did not comply with the section cited above as the trash cans do not have tight fitting lids which poses a potential health and safety risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
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2
3
4
Licensee will obtain trash cans with tight fitting lids then send pictures to CCLD by 12/2/22.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in four out of six staff members had none or incomplete records which poses a potential health risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
1
2
3
4
Licensee will submit complete immunization for the four staff members to CCLD by 12/2/22
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:
11/17/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/17/2022
LIC809
(FAS) - (06/04)
Page:
7
of
7
Document Has Been Signed on
11/17/2022 04:54 PM
- It Cannot Be Edited
Created By:
Indira Loza
On
11/17/2022
at
03:25 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:
11/17/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in four out of six files reviews which poses potential health and safety risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
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2
3
4
Licensee will have staff members complete Mandated reporter training (general and caregiver) then send proof to CCLD by 12/2/22.
Type B
Section Cited
CCR
101215.1(m)
Child Care Center Director Qualifications and Duties
(m) A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in two out of two which poses a potential safety risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
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2
3
4
Licensee will complete 16 hours of Health and Safety training along with the assistant director then submit proof to CCLD by 12/2/22.
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:
11/17/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/17/2022
LIC809
(FAS) - (06/04)
Page:
5
of
7
Document Has Been Signed on
11/17/2022 04:54 PM
- It Cannot Be Edited
Created By:
Indira Loza
On
11/17/2022
at
03:25 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:
11/17/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in two out of six file reviews which poses a potential health and safety risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
1
2
3
4
Licensee will obtain LIC503 for the two staff members then send them to CCLD by 12/2/22.
Type B
Section Cited
CCR
101217(a)(13)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) A signed statement regarding their criminal record history as required by Section 101170(d).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in two out of six file reviews which poses safety risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
1
2
3
4
Licensee will fill out LIC508 then send copies to CCLD by 12/2/22.
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:
11/17/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/17/2022
LIC809
(FAS) - (06/04)
Page:
6
of
7
Document Has Been Signed on
11/17/2022 04:54 PM
- It Cannot Be Edited
Created By:
Indira Loza
On
11/17/2022
at
03:25 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:
11/17/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in two out of six files which poses a potential health risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
1
2
3
4
The licensee will obtain medical assessments for the children missing the form and send them to CCLD by 12/2/22.
Type B
Section Cited
CCR
101220.1(a)
Immunizations
(a) Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, commencing with Section 6000.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in two out of six files which poses a potential health rights risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
1
2
3
4
Licensee will send proof of immunization for the two children in care to CCLD by 12/2/22.
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:
11/17/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/17/2022
LIC809
(FAS) - (06/04)
Page:
3
of
7
Document Has Been Signed on
11/17/2022 04:54 PM
- It Cannot Be Edited
Created By:
Indira Loza
On
11/17/2022
at
03:25 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:
11/17/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101223(b)(1)
Personal Rights
(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in one out of six file reviews which poses a potential personal rights risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
1
2
3
4
Licensee will review all children's files and come up with a checklist to ensure all records are complete; then send the checklist to CCLD by 12/2/22
Type B
Section Cited
CCR
101226(e)(3)(B)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in one out of six files which poses a potential health risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
1
2
3
4
Licensee will review all medications and ensure the correct forms match the medication provided. Then send a copy of where the medication will be stored, what is needed from parents and what forms need to be filled out to CCLD by 12/2/22.
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:
11/17/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/17/2022
LIC809
(FAS) - (06/04)
Page:
2
of
7
Document Has Been Signed on
11/17/2022 04:54 PM
- It Cannot Be Edited
Created By:
Indira Loza
On
11/17/2022
at
03:25 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:
11/17/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(6)
Health-Related Services
(6) When no longer needed by the child, or when the child withdraws from the center, all medications shall be returned to the child's authorized representative or disposed of after an attempt to reach the authorized representative.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in three out of three medications which poses a potential health risk to persons in care.
POC Due Date:
12/02/2022
Plan of Correction
1
2
3
4
The licensee will remove or return expired medications and medication for children no longer at the center. Then send a plan to CCLD to ensure all medication at the center is current by 12/2/22.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
11/17/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/17/2022
LIC809
(FAS) - (06/04)
Page:
4
of
7