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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420951
Report Date: 11/22/2022
Date Signed: 11/22/2022 04:56:09 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/22/2022 04:56 PM - 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:GLOBAL MONTESSORI INTERNATIONAL SCHOOLFACILITY NUMBER:
013420951
ADMINISTRATOR:TENG, VIVIFACILITY TYPE:
850
ADDRESS:2830 - 9TH STTELEPHONE:
(510) 845-6969
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:90CENSUS: 0DATE:
11/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Vivi TengTIME COMPLETED:
02:35 PM
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Attempted Unannounced Required 1 Year Annual Inspection.

Licensing Program Analyst (LPA) LPA Domantay arrived unannounced at the facility at 2:15pm on 11/22/2022 to conduct a visit to conduct unannounced required 1 year annual inspection. LPA attempted to ring the door bell at the office front door of facility 3 times, but no answer. LPA attempted to contact facility at 510-845-6969, but no answer. LPA did not observe or hear any staff or children present at facility during attempted visit. LPA will conduct annual at a later time.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Melissa DomantayTELEPHONE: 510-725-7021
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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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