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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420975
Report Date: 08/31/2022
Date Signed: 08/31/2022 05:29:28 PM

Document Has Been Signed on 08/31/2022 05:29 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: 46DATE:
08/31/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:16 PM
MET WITH:Cynthia ReimannTIME COMPLETED:
05:45 PM
NARRATIVE
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On 8/31/22, at 3:05PM, Licensing Program Analyst (LPA) Catherine Fernandes and Licensing Program Manager (LPM) Loretta Dyson arrived on a unannounced case management inspection. LPA and LPM met with Yaneldis Diaz. Around 3:50pm Director/Owner Cynthia Reiman arrived. Present in care were seven infants, 22 preschoolers and 17 school age children.

During the inspection LPA and LPM observed no current menu posted and the center roster did not reflect the children enrolled.


The attached type B deficiencies are being cited today, see 809D.



Exit interview conducted
Report and Appeal provided
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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 08/31/2022 05:29 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 08/31/2022 at 04:18 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: 08/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2022
Section Cited
CCR
101227(a)(6)

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Food Service- Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days...This requirement has not been met as evidenced by.
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Director/ Owner will come up with a menu that will reflect what is being served to the children while in care 1 week prior to serving. Then send a copy to CCLD by POC date.
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Based on observations and conformation there is not a current posted menu that reflects what is being served to children, which poses a potential health risk to children in care.
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Type B
09/09/2022
Section Cited
HSC1596.841

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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician... This requirement has not been met as evidenced by..
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Director/owner will update the roster to reflect who is enrolled and when past children left, then send the current roster to CCLD by POC date.
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Based on observations and conformation the center roster is not current and does not reflect what children are enrolled at the center, which is a potential safety risk to 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: 08/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022


LIC809 (FAS) - (06/04)
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