073408897-6-1-2023-02-CC-SJON-CSZLSR-20230621090106

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073408897
Report Date: 06/01/2023
Date Signed: 06/01/2023 10:42:49 AM

Unsubstantiated

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
04/13/2023 and conducted by Evaluator Monica Mathur

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20230413163417

FACILITY NAME:	FOUNTAINHEAD MONTESSORI SCHOOL-PLEASANT HILL		FACILITY NUMBER:	073408897
ADMINISTRATOR:	RIZVI, SUMAIRA		FACILITY TYPE:	850
ADDRESS:	1715 OAK PARK BOULEVARD		TELEPHONE:	(925) 967-2655
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	99	CENSUS: 23	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Sumaira Rizvi		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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9

Care & Supervision: Staff did not properly supervise day care child(ren) while in care

INVESTIGATION FINDINGS:

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On 6/1/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Subsequent Complaint Investigation at Fountainhead Montessori School Pleasant Hill. LPA met with Director, Sumaira Rizvi and explained the purpose of today’s inspection. The finding for the above allegation was delivered. During the course of the investigation LPA completed a physical plant inspection, reviewed facility records and conducted interviews. Complainant alleges staff did not properly supervise day care child(ren) while in care. At this time, it could not be determined that any incident occurred due to lack of supervision. Staff stated they place themselves strategically during indoor and outdoor activities to supervise children at all times. They denied witnessing any incident involving Child C1 during outdoor activity. Due to insufficient evidence and information, it could not be determined any incident occurred or if there was lack of supervision. Center does not have CCTV on campus.
Based on the interviews and information obtained throughout the investigation, the allegation is UNSUBSTANTIATED which means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiency has been cited for this allegation. LPA issued a technical violation. Exit interview was conducted with Director, Sumaira Rizvi. A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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 9

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
04/13/2023 and conducted by Evaluator Monica Mathur

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20230413163417

FACILITY NAME:	FOUNTAINHEAD MONTESSORI SCHOOL-PLEASANT HILL		FACILITY NUMBER:	073408897
ADMINISTRATOR:	RIZVI, SUMAIRA		FACILITY TYPE:	850
ADDRESS:	1715 OAK PARK BOULEVARD		TELEPHONE:	(925) 967-2655
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	99	CENSUS: 23	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Sumaira Rizvi		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

1
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5
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7
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9

Personal Rights - Staff did not ensure that day care child's toileting and hygiene needs were met while in care

INVESTIGATION FINDINGS:

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13

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 9

Control Number 02-CC-20230413163417

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: 06/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/08/2023 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	101223 Personal rights(a)The licensee shall ensure that each child is accorded the following personal rights (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	By POC due date 6/8/23 Director agreed to submit a written plan on how facility will be in compliance with this regulation moving forward
	8 9 10 11 12 13 14	Based on investigation, on 3/28/23 C1 had frequent bowel movements while in care, used bathroom several times. S1, S2 stated they helped C1 few times, but were unaware clothes were soiled. Soiled clothes were noticed by parent at home and facility was notified. Staff stated they were unsure how many times C1 used bathroom or how many times staff provided help. Toilet chart shows the child used bathroom 2 times, although S1,S2 stated the child went more than 2 times. Photos of soiled clothes were provided as proof	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 06/01/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 9

Control Number 02-CC-20230413163417

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: 06/01/2023

NARRATIVE

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continued from 9099A

During interviews staff were not sure how many times the child used bathroom that day or how many times staff provided help. Toilet chart shows the child used bathroom 2 times, although during interviews S1,S2 stated the child went more than 2 times. Photos of soiled clothes were provided as proof. Information and evidence obtained determines staff failed to meet toileting and hygiene needs of the child, which poses/posed a potential risk to health and safety of child/ren in care. Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. Deficiency is being cited on 9099-D page. Exit interview was conducted with Director, Sumaira Rizvi. A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 9

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
04/13/2023 and conducted by Evaluator Monica Mathur

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20230413163417

FACILITY NAME:	FOUNTAINHEAD MONTESSORI SCHOOL-PLEASANT HILL		FACILITY NUMBER:	073408897
ADMINISTRATOR:	RIZVI, SUMAIRA		FACILITY TYPE:	850
ADDRESS:	1715 OAK PARK BOULEVARD		TELEPHONE:	(925) 967-2655
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	99	CENSUS: 23	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Sumaira Rizvi		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights - Staff did not prevent day care child from bullying other day care child(ren) while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
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7
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9
10
11
12
13

On 6/1/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Subsequent Complaint Investigation at Fountainhead Montessori School Pleasant Hill. LPA met with Director, Sumaira Rizvi and explained the purpose of today’s inspection. The finding for the above allegation was delivered. During the course of the investigation LPA completed a physical plant inspection, reviewed facility records and conducted interviews. Complainant alleges staff did not prevent day care child from bullying other day care child(ren) while in care. During course of investigation, it was determined that there is insufficient evidence and information to support that Child C1 was consistently bullied by Child C2 and that staff did not prevent bullying incidents. Staff stated C2 has body control issues and is closely monitored. Staff stated they supervise children visually at all times. Difficult behaviors are managed and communicated with parents as needed. Based on the interviews and information obtained throughout the investigation, the allegation is UNSUBSTANTIATED which means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiency has been cited for this allegation. LPA issued a technical assistance note. Exit interview was conducted with Director, Sumaira Rizvi. A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 9

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
04/13/2023 and conducted by Evaluator Monica Mathur

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20230413163417

FACILITY NAME:	FOUNTAINHEAD MONTESSORI SCHOOL-PLEASANT HILL		FACILITY NUMBER:	073408897
ADMINISTRATOR:	RIZVI, SUMAIRA		FACILITY TYPE:	850
ADDRESS:	1715 OAK PARK BOULEVARD		TELEPHONE:	(925) 967-2655
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	99	CENSUS: 23	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Sumaira Rizvi		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal rights - Staff encouraged day care child to not report incidents to their authorized representative

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 6/1/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Subsequent Complaint Investigation at Fountainhead Montessori School Pleasant Hill. LPA met with Director, Sumaira Rizvi and explained the purpose of today’s inspection. The finding for the above allegation was delivered. During the course of the investigation LPA completed a physical plant inspection, reviewed facility records and conducted interviews. Complainant alleges staff encouraged day care child to not report incidents to their authorized representative. There is insufficient evidence or information to indicate staff encouraged child C1 not to report incidents to authorized representative. Staff stated children are encouraged to be verbal, use their words to express concerns and feelings so they can be helped. Based on the interviews and information obtained throughout the investigation, the allegation is UNSUBSTANTIATED which means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiency has been cited for this allegation. LPA issued a technical advisory assistance note. Exit interview was conducted with Director, Sumaira Rizvi. A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 6 of 9