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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270857
Report Date: 06/19/2019
Date Signed: 06/19/2019 10:02:17 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:FOUNTAIN VALLEY MONTESSORI CENTERFACILITY NUMBER:
304270857
ADMINISTRATOR:MEHTA, SNEHAFACILITY TYPE:
850
ADDRESS:18410 BROOKHURST STREETTELEPHONE:
(714) 593-8333
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:144CENSUS: 101DATE:
06/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director Sneha MehtaTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Thuy Ho conducted a case management inspection to confirm the removal of a staff member at this facility. LPA met with directors, Sneha Mehta. Census were taken as follow: 101 preschool children with 20 staff members . Based on the instruction letter from the Caregiver Background Check Bureau, the director confirmed the removal of the staff member. The Director stated the the staff member was removed on 6/14/19. The director has requested to disassociate this staff member from the facility license number.

A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

No deficiency observed during today's inspection. .

Exit interview conducted. The Notice of Site Visit was posted. Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. LPA informed the licensee of how to access regulations and forms from CCLD websites. This report is to be on file and accessible for public review at the facility for at least 3 years.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 703-2824
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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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