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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408897
Report Date: 04/12/2023
Date Signed: 04/12/2023 09:11:39 AM

Document Has Been Signed on 04/12/2023 09:11 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: 105CENSUS: 20DATE:
04/12/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sumaira RizviTIME COMPLETED:
09:30 AM
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On 4/12/23 Licensing Program Analysts (LPAs) Monica Mathur and Christina Watts conducted an unannounced Case Management - Plan of Correction inspection at Fountainhead Montessori School Pleasant Hill. LPAs met with Director Sumaira Rizvi and explained purpose of today's visit.

Purpose is to clear deficiencies cited on Case Management inspection report of 4/10/23 and Complaint Report of 3/22/23. Facility has submitted plans of correction and taken necessary corrective actions. Letters of Clearance were provided.

No deficiency was cited today. This report was reviewed with Director, Sumaira Rizvi.
NOTICE OF SITE VISIT WAS ISSUES, MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
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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