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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405026
Report Date: 04/10/2024
Date Signed: 04/10/2024 03:54:43 PM

Document Has Been Signed on 04/10/2024 03:54 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:SPRINGFIELD MONTESSORI SCHOOLFACILITY NUMBER:
073405026
ADMINISTRATOR/
DIRECTOR:		SHASHI LALFACILITY TYPE:
850
ADDRESS:2780 MITCHELL DRIVETELEPHONE:
(925) 944-0626
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 226TOTAL ENROLLED CHILDREN: 173CENSUS: 152DATE:
04/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Rachel JacobsenTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 4/10/24 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Case Management - Incident inspection at Springfield Montessori and met with Campus Coordinator, Rachel Jacobsen. Licensee/Director, Shashi Lal was not present on campus at the time of visit. Purpose of today’s inspection is to follow up on an incident that the facility reported to Licensing Department on 3/27/24.

Facility reports that a child's parent expressed concerns about the room teacher roughly mishandling their child. During today's inspection, LPA conducted interviews, reviewed files and obtained relevant documents.

At this time, the allegation NEEDS FURTHER INVESTIGATION. No deficiencies were issued during today's inspection. Exit interview was conducted, this report was reviewed and discussed with Campus Coordinator, Rachel Jacobsen.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2024
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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