093616872-6-15-2021-03-CC-MPAL-C3ZVQX-20210615163905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093616872
Report Date: 06/15/2021
Date Signed: 06/15/2021 04:39:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	MADRONE MONTESSORI SCHOOL, LLC		FACILITY NUMBER:	093616872
ADMINISTRATOR:	CAMPBELL, KRISTA		FACILITY TYPE:	850
ADDRESS:	5001 WINDPLAY DRIVE #1		TELEPHONE:	(530) 676-4110
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	74	CENSUS: 22	DATE:	06/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Krista Campbell		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Michelle Pascual met with the Director Krista Campbell for an unannounced annual random Visit. LPA toured the facility, including all activity/classroom areas. LPA reviewed care and supervision of children, staffing ratios, health related services, including medications, first aid supplies, furniture and equipment. Center operation hours are Monday to Friday 7:00a to 6:00p. LPA observed all required forms to be posted. The sleeping mats and sheets are available for children enrolled. Sheets are laundered weekly. There are adequate toys and equipment available for children in care. Children's snacks are provided by the center during the morning & afternoon and meals are provided by the school. LPA reviewed a sample of children and staff files and sign/in-sign/out sheets. Playground equipment is in good working order and there is adequate shade and water provided. At least one staff member present today has current Pediatric CPR and First Aid (expires 06/22) as well as Mandatory Reporter Training, which expires 06/22.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MADRONE MONTESSORI SCHOOL, LLC	FACILITY NUMBER: 093616872
	VISIT DATE: 06/15/2021

NARRATIVE

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LPA provided the Licensing Agency website (www.ccld.ca.gov), so the director and/or staff may obtain updated licensing information, regulations, and forms.

This facility does not provide IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on today's visit there are no title 22 deficiencies noted.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

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