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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408897
Report Date: 03/22/2023
Date Signed: 04/12/2023 09:12:34 AM

Document Has Been Signed on 04/12/2023 09:12 AM - It Cannot Be Edited

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: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: 99TOTAL ENROLLED CHILDREN: 101CENSUS: 20DATE:
03/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Sumaira RizviTIME COMPLETED:
05:00 PM
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*AMENDED REPORT*

On 03/22/2023 at 3:30 PM, Licensing Program Analysts (LPAs) Christina Watts and Monica Mathur conducted a Case Management - Deficiencies inspection at Fountainhead Montessori School - Pleasant Hill. LPAs met with Director, Sumaira Rizvi and explained the purpose of today's inspection.

During today's inspection, it was discovered that there had been sighting of a mouse in the Toddler's classroom on 03/17/2023. Multiple interviews conducted stated that classroom was only shut down on Friday, 03/17/2023. During the investigation, it was discovered that mouse dropping were seen on Monday, March 20, 2023 and Tuesday March 21, 2023. Multiple interviews stated that the Director did contact the owner to have Pest Control come to the facility to inspect the classroom. While interviews stated that the classroom was deep cleaned on Monday and Tuesday, the facility did not disclosed to parents/authorized representative and licensing of the sighting of a mouse and droppings. While this incident did occur, LPA did not observed any violations.

Exit interview conducted and report was reviewed with the Director, Sumaira Rizvi. A Notice of Site Visit was given and must remain posted for 30 consecutive days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document is an Amendment of Original Document on 04/11/2023 03:45 PM


Created By: Christina Watts On 03/22/2023 at 03:49 PM
Link to Parent Document Below:
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: FOUNTAINHEAD MONTESSORI SCHOOL-PLEASANT HILL
FACILITY NUMBER: 073408897

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed




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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Christina Watts
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023


LIC809 (FAS) - (06/04)
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