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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070211836
Report Date: 06/08/2022
Date Signed: 06/08/2022 12:56:50 PM


Document Has Been Signed on 06/08/2022 12:56 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:FOUNTAINHEAD MONTESSORI SCHOOL ORINDA CAMPUSFACILITY NUMBER:
070211836
ADMINISTRATOR:NOELL WHITEFACILITY TYPE:
850
ADDRESS:30 SANTA MARIA WAYTELEPHONE:
(925) 254-7110
CITY:ORINDASTATE: CAZIP CODE:
94563
CAPACITY:129CENSUS: 39DATE:
06/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Noell WhiteTIME COMPLETED:
01:30 PM
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On 06/08/2022 at 12:34AM Licensing Program Analysts (LPA) Ashley Curry conducted an unannounced case management for an Amended Report. LPA met with the director, Noell White and the Amended Report was discussed.


An exit interview was conducted, the report was discussed and signed. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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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