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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416606
Report Date: 01/19/2024
Date Signed: 01/19/2024 03:29:01 PM

Document Has Been Signed on 01/19/2024 03:29 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MONTESSORI SCHOOL AT FIVE CANYONSFACILITY NUMBER:
013416606
ADMINISTRATOR:VAN GROENOU, MEHERFACILITY TYPE:
850
ADDRESS:22781 CANYON COURTTELEPHONE:
(510) 581-3729
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94552
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 60DATE:
01/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Martha SanchezTIME COMPLETED:
03:45 PM
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On 01/19/2024 at 2:15pm, Licensing Program Analyst (LPA) Christina Uribe conducted a Case Management visit to the facility and met with site director, Martha Sanchez. Also present during today's inspection is 60 children and 11 staff.

The purpose of today's visit is to review recent documentation that was received by the facility by the representative of a child that is enrolled in the facility's program. These documents are official court documents which discusses the custody of the child and the restrictions that one of the child's parents has in place. LPA Uribe and the director reviewed and discussed these documents for clarification and consultation.
The director has informed the staff of these orders by the court and all are aware of the stipulations to be followed.

A notice of site visit was given and must be posted for 30 days. Exit interview conducted and report was reviewed with the director, Martha Sanchez.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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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