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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093623955
Report Date: 01/07/2022
Date Signed: 01/07/2022 12:04:14 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:CAMERON PARK MONTESSORI SCHOOL INCFACILITY NUMBER:
093623955
ADMINISTRATOR:ANNE BEEMAN, KIMBERLYFACILITY TYPE:
830
ADDRESS:4140 MOTHERLODE DRIVE STE 104TELEPHONE:
(530) 677-1776
CITY:SHINGLE SPRINGSSTATE: CAZIP CODE:
95682
CAPACITY:12CENSUS: 5DATE:
01/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Kimberly BeemanTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Martinez conducted a visit with LPA Lor and Director Kimberly Beeman. Today's visit was to ensure the room usage for the infant area to include the toddler option. During today's visit the infant room was toured and the room was observed with a working sink and a changing table. Potty training toilets were also observed. The infant license will only be used for children 18 months to 36 months. The toddler option addition to the room is approved as of today.

Notice of site visit must be posted for 30 days. No citations were issued.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (916) 862-1086
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
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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