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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402302
Report Date: 10/20/2023
Date Signed: 10/20/2023 05:26:29 PM

Document Has Been Signed on 10/20/2023 05:26 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ANGELS MONTESSORI PRESCHOOL - CONCORDFACILITY NUMBER:
073402302
ADMINISTRATOR:KARAMPOUR, ANGELFACILITY TYPE:
850
ADDRESS:1566 BAILEY ROADTELEPHONE:
(925) 686-5621
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 49TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/20/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Maryam KarampourTIME COMPLETED:
05:30 PM
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On October 20, 2023, Licensing Program Analyst (LPA) Randall Dunevant and Licensing Program Manager (LPM) Loretta Dyson conducted an unannounced Case Management visit to clear Plan of Correction (POC) deficiencies for lack of supervision and multiple housekeeping issues with the facilities physical plant. LPA met with director Maryam Karampour. Present during the inspection were 4 children in care and a Behavioral Tech. The POC for supervision is cleared by licensee/director and teacher watching Care and Supervision video on the CCLD web page. The deficiency for housekeeping still requires additional action by licensee.

A civil penalty is being assessed for a citation(s) listed on this report. You will receive a bill in the mail. Payment is due when billed. Payment must be made by a personal, business or cashier check, or a money order made payable to the "California Department of Social Services". Please write the facility number and invoice number on your check and include a copy of your bill with the payment. You will find the invoice number on your bill. DO NOT SEND CASH.



The facility has a plan to complete the housekeeping over the this weekend. No deficiency cited during today visit. Appeal Rights provided.

Exit interview conducted with Maryam Karampour, Notice of Site visit given and must remain posted for 30 days.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Randall Dunevant
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2023
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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