Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420906
Report Date: 05/08/2018
Date Signed 05/08/2018 12:36:36 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) 651-2605
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:100CENSUS: 45DATE:
05/08/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Gauri MahajanTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Mayla Mendoza conducted an unannounced ANNUAL/RANDOM inspection. LPA met with Director, Gauri Mahajan. The center was toured inside and out for health and safety inspection.

PHYSICAL PLANT: There are no bodies of water nor any firearms/weapons in the premises. Storage for poisons/detergents, cleaning supplies, medications are inaccessible to children. Furniture and equipment are free of sharp parts. Indoor and outdoor surfaces are clean and toxic free. Toilets, handwashing equipment are safe and in sanitary condition. There is a separate staff bathroom. Food preparation area are clean. Food are protected against contamination. Waste containers have tight fitting covers. There is a menu posted and there are no cleaning supplies stored with food. Breakfast, lunch and snacks are provided by the center. There is a variety of food available for children. Water is available indoors and outdoors. The center is free of flies, other insects and rodents. LPA inspected that there is a fully charged fire extinguisher, smoke and carbon monoxide detector and first aid kit is available. Heating, lighting and air conditioner is adequate. INSPECTION of OUTDOOR PLAY AREA: Playground equipment is in good condition and outdoor activity space is maintained in a safe condition and free of any hazards. Climbing equipment is properly anchored to the ground with adequate and appropriate cushioning material to absorb falls. There is an adequate shade provided for the children. There are cots available for children's use. Beddings and sheets are stored properly. FACILITY ADMINISTRATION: The director is aware that any authorized employee of the Department may enter and inspect the center with or without advance notice. The licensee understands that prior to working or volunteering in a licensed child care facility, all individuals subject to criminal record review shall obtain a clearance or criminal record exemption. If the department notifies the licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons, the licensee shall comply. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off site activities.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Mayla MendozaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2018
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LITTLE FLOWERS MONTESSORI
FACILITY NUMBER: 013420906
VISIT DATE: 05/08/2018
NARRATIVE
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EVALUATION OF CARE AND SUPERVISION: The facility is operating within its licensed capacity. The facility is within ratio today with one teacher supervising no more than 12 children. Constant supervision including visual supervision is provided at all times. RECORD REVIEW: A physical census was taken of all children present and cross-referenced with the sign in and out sheets. LPA reviewed a percentage of children and personnel records. Opening and closing staff have their current CPR and first aid training. LPA obtained a copy of the most current LIC500. POSTING REQUIREMENTS: License and other relevant notices are visible for public views and correctly posted on the wall. Fire and disaster drills are being conducted as scheduled every six months. Staff have completed the mandated reporting training and certificates are placed in their respective files. The director was encouraged to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. http://www.ccld.ca.gov/res/pdf/15CCC-02.pdf. 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 attached type A deficiency is cited today. Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports is to be placed in each child's file. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted and a site visit was posted.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Mayla MendozaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2018
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: LITTLE FLOWERS MONTESSORI
FACILITY NUMBER: 013420906
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2018
Section Cited
CCR
101170(e)(1)
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101170(e)(1) Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption.
ELVA GRANADOS WAS PRESENT TODAY WITHOUT A CRIMINAL RECORD CLEARANCE
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BY 5/9/18-ELVA GRANADOS SHALL NOT BE PRESENT UNTIL SHE HAS RECEIVED A CRIMINAL RECORD CLEARANCE. CENTER SHALL INFORM LPA MAYLA MENDOZA ONCE MS. GRANADOS HAS RECVD A CRIMINAL RECORD CLEARANCE.
See LIC 421B
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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: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Mayla MendozaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2018
LIC809 (FAS) - (06/04)
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