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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408897
Report Date: 08/06/2021
Date Signed: 08/06/2021 04:28:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/12/2021 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20210712123858
FACILITY NAME:FOUNTAINHEAD MONTESSORI SCHOOL-PLEASANT HILLFACILITY NUMBER:
073408897
ADMINISTRATOR:RIZVI, SUMAIRAFACILITY TYPE:
850
ADDRESS:1715 OAK PARK BOULEVARDTELEPHONE:
(925) 967-2655
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:72CENSUS: 12DATE:
08/06/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sumaira RizviTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Other - Admission agreement - did not give authorized representative notice of temination of services, as per the contract.
INVESTIGATION FINDINGS:
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On 8/6/21at 2:30 pm Licensing Program Analysts (LPAs) Monica Mathur and Michelle Sutton conducted an Unannounced Subsequent Complaint Investigation at Fountainhead Montessori Pleasasnt Hill. LPAs met with Director. Finding for the above allegation was delivered during the inspection. Complainant alleges that faciliity did not give authorized representative notice of temination of services, as per the contract. During the course of the investigation, LPA inspected the facility, reviewed records, and conducted interviews.

It was determined that Child 1's enrollment was terminated without any prior notice, therefore not abiding by Parent Handbook, Plan of Operation and Admission Agreement contract which states 7 day notice shall be given. This is a violation of contractual admission agreement requirements per Title 22 regulations. Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 02-CC-20210712123858
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: FOUNTAINHEAD MONTESSORI SCHOOL-PLEASANT HILL
FACILITY NUMBER: 073408897
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied: Appeal Not Submitted Timely
Type B
08/13/2021
Section Cited
CCR
101173(d)
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101173 Plan of Operation (d) The child care center shall operate in accordance with the terms specified in the plan of operation.
. This requirement is not met as evidenced by:
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By end of 8/13/21 Director agreed to send a written statement about how center will ensure admission agreement and plan of operation shall be followed moving forward.
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Per LPAs investigation Child 1's enrollment was terminated without any prior notice, therefore not abiding by Parent Handbook and Admission Agreement contract which states 7 day notice shall be given. This is a potential risk to health and safety of child.
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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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 02-CC-20210712123858
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: FOUNTAINHEAD MONTESSORI SCHOOL-PLEASANT HILL
FACILITY NUMBER: 073408897
VISIT DATE: 08/06/2021
NARRATIVE
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Exit interview was conducted, where this report, the deficiency, plan of correction, and appeal rights were discussed with Director.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4