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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408897
Report Date: 06/26/2023
Date Signed: 06/26/2023 11:27:36 AM

Document Has Been Signed on 06/26/2023 11:27 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: 104CENSUS: 78DATE:
06/26/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sumaira RizviTIME COMPLETED:
12:00 PM
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On 6/26/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Plan of Correction inspection at Fountainhead Montessori School Pleasant Hill. LPA met with Director, Sumaira Rizvi and explained purpose of inspection.

Purpose is to inspect facility and clear citation issued for Care & Supervision during Case Management inspection of 6/21/23. During today's inspection LPA conducted facility walk through, observed rooms and play ground. All staff were actively supervising children indoor and outdoor. Director has submitted plan of correction, met each staff individually, developed and discussed children supervision plan for facility and will be holding all staff training. Report dated 6/21/23 citing Type A has been provided to most parents and Statement Acknowledging Receipt of Licensing Reports LIC9224 has been obtained. Citation issued on 6/21/23 is cleared today and Letter of Clearance was provided. Director was reminded the citation is cleared by plan of correction submitted but will remain on facility's record.

No deficiency was cited today. Present in the facility were 78 children. This report was reviewed with Director, Sumaira Rizvi. NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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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