Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420906
Report Date: 01/06/2016
Date Signed 01/06/2016 06:20:53 PM

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:LITTLE FLOWERS MONTESSORIFACILITY NUMBER:
013420906
ADMINISTRATOR:MAHAJAN, GAURIFACILITY TYPE:
850
ADDRESS:4343 STEVENSON BLVDTELEPHONE:
(510) 651-0515
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:100CENSUS: 85DATE:
01/06/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:DIRECTOR G MAHAJANTIME COMPLETED:
06:30 PM
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LPA AL WONG CONDUCTED A (3) RANDOM ANNUAL VISIT TO THIS PRESCHOOL CENTER. THERE WAS NOT ENOUGH TIME FOR LPA TO COMPLETE THE CHILDREN & STAFF RECORDS REVIEW SO LPA WILL RETURN TO THIS CENTER IN THE NEAR FUTURE. MEDICATION, FIRE DRILL & SIGN IN/OUT LOGS AND CHILDREN'S ROSTER WERE REVIEWED. NO MEDICATION NOR IMS IS ADMINISTERED TO ANY CHILD AT THE PRESENT TIME; CENTER WILL SUBMIT AN UPDATED PLAN OF OPERATION IF IN THE FUTURE THEY PROVIDE ANY IMS SERVICES TO A CHILD IN CARE. PROPER FOOD GROUPS ARE SERVED FOR SNACK &/OR LUNCH. CLEANSERS & MEDICINES WERE KEPT OUT OF REACH OF CHILDREN. THERE IS A SMOKE/CARBON MONOXIDE DETECTOR. 1ST AID KIT WAS INSPECTED. STAFF 1ST AID/CPR CERTIFICATES ARE CURRENT. GROUNDS WERE INSPECTED. DIRECTOR IS AWARE OF THE IMMEDIATE $150.00 CIVIL PENALTY FOR A REPEAT TYPE A DEFICIENCY WITHIN 12 MONTHS & THE UP TO $500.00 CIVIL PENALTY FOR FAILURE TO OBTAIN FINGERPRINT & CHILD ABUSE CLEARANCES FROM THE DEPT OF JUSTICE FOR ANY NEW STAFF PRIOR TO HAVING CONTACT WITH CHILDREN.

THERE ARE NO PHYSICAL PLANT OR RATIO/CAPACITY DEFICIENCIES CITED TODAY.

A review of records indicate that all facility staff or other individuals who required caregiver background checks have received criminal record & child abuse index clearances or exemptions.

NOTICE OF SITE DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY. IT MUST REMAIN POSTED FOR 30 DAYS. FAILURE TO DO SO WILL RESULT IN A $100 PENALTY FINE.

DIRECTOR IS ALSO AWARE THAT PARENTS ARE TO RECEIVE A COPY OF ANY FUTURE CITED TYPE A DEFICIENCY INSPECTION REPORT & THAT A PARENTS' SIGNED "ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORT" FORM IS TO BE KEPT IN EACH CHILD'S FILE.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Al WongTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2016
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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