073408292-11-15-2023-02-CC-ACUY-CXLQZ9-20231115113621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408292
Report Date: 11/15/2023
Date Signed: 11/15/2023 11:37:39 AM

Document Has Been Signed on 11/15/2023 11:37 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	LAMORINDA MONTESSORI LLC		FACILITY NUMBER:	073408292
ADMINISTRATOR:	MICHELLE OLIVARES-MANNING		FACILITY TYPE:	830
ADDRESS:	1450 MORAGA RD.		TELEPHONE:	(925) 377-0407
CITY:	MORAGA	STATE: CA	ZIP CODE:	94556
CAPACITY:	12	CENSUS: 0	DATE:	11/15/2023
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Antonio Betts		TIME COMPLETED:	11:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/15/2023 at 10:30 AM Regional Manager Diane Perez, Licensing Program Manager Loretta Dyson, Licensing Program Analyst Ashley Curry, and Licensing Program Analyst Brittany Crass met with the Administrator Antonio Betts and Owner Andrew Betts for a Non-Compliance Conference. The facility was cited the following deficiencies: Type A: 101161(a) Limitations on Capacity- The facility was not operating within the capacity of 12, which is specified on the license. LPA observed 14 infants in care. 101170(e) Criminal Record Clearance- 1 staff working in the facility did not have eligible clearance. Type B: 1596.7995(a)(1) Immunization Requirements- 4 out 4 staff did not have required immunization records in file. 101419.2(b)(2) Individual Sleeping Plan- 3 children did not have the LIC 9227 Individual Sleeping Plan form in file. The Type A deficiencies were cited on 09/19/2023 with a plan of correction due date of 09/20/2023. After follow up, the deficiencies were cleared. The facility indicated they understand the importance of clearing the cited deficiencies and coming back into compliance prior to the POC due dates.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley Curry	TELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LAMORINDA MONTESSORI LLC	FACILITY NUMBER: 073408292
	VISIT DATE: 11/15/2023

NARRATIVE

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Record of compliance is extremely important and will weigh heavily in our decision of administrative action if warranted.

If you have any questions regarding the interpretation of licensing regulations, please contact your analyst Ashley Curry or the Licensing office for general concerns.

As discussed in the Plan of Correction, licensee will remain in compliance with all CCL rules and regulations.

During the course of the meeting, the facility agrees upon the following:

The administrator agreed to only operate within the capacity and limitations specified on the licence.
The administrator indicated he has difficulties accessing Guardian. The administrator agreed to contact the Oakland Regional office to verify the status of staff's criminal record clearance. The Department will contact Guardian to assist the administrator with creating an account with Guardian.
The administrator assured all staff and children have complete files.
The administrator agreed to submit documentation for new director.

Technical Support Program (TSP) was offered to the licensee. The administrator agreed to TSP and a referral will be made.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley Curry	TELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC809 (FAS) - (06/04)

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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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LAMORINDA MONTESSORI LLC	FACILITY NUMBER: 073408292
	VISIT DATE: 11/15/2023

NARRATIVE

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Licensee has been advised that failure to complete the above agreed upon actions by the dates will result in this Department taking the following action(s):

Failure to comply with the previously mentioned requirements may result in administrative action against the license.

The licensee was advised that the facility will have more frequent visits, to help ensure compliance with Title 22 regulations at all times.

Exit interview conducted, appeal right were given, and report was reviewed with Antonio Betts and Andrew Betts.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley Curry	TELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC809 (FAS) - (06/04)

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