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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422436
Report Date: 04/20/2023
Date Signed: 04/20/2023 04:37:54 PM


Document Has Been Signed on 04/20/2023 04:37 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:GLOBAL VILLAGE MONTESSORIFACILITY NUMBER:
013422436
ADMINISTRATOR:PRAGATI MATHURFACILITY TYPE:
850
ADDRESS:4807 HOPYARD RD.TELEPHONE:
(925) 425-7455
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:120CENSUS: 49DATE:
04/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:21 PM
MET WITH:Pragati MathurTIME COMPLETED:
05:05 PM
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On April 20, 2023 License Program Analyst (LPA) Lorraine Dacanay Breaux met with Director, P. Mathur, to conduct an unannounced Case Management/Other visit due to a complaint filed against the facility's license.

Due to the facility failing to report an injury to CCLD within 24 hours by phone and submitting and Unusual Incident Report (LIC 624) with in the required time frame. LPA discussed the steps of reporting to CCLD and the director understands the requirements.

The director was inform to report this incident and to submit LIC 624,

Exit Interview conducted. Appeal Rights provided and Notice of site visit provided and must remain posted for 30 days. Exit interview conducted with director, Pragati Mathur.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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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