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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240403488
Report Date: 12/05/2019
Date Signed: 12/05/2019 12:46:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MERCED MONTESSORI SCHOOLFACILITY NUMBER:
240403488
ADMINISTRATOR:MACDONALD ANNFACILITY TYPE:
850
ADDRESS:424 W 21ST STREETTELEPHONE:
(209) 722-9823
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY:44CENSUS: 21DATE:
12/05/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ann MacDonald - OwnerTIME COMPLETED:
01:15 PM
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On 12/5/2019 Licensing Program Analyst (LPA), Joseph Pacheco arrived at the child care center to conduct an unannounced Case Management - Plan of Correction (POC) Inspection. LPA met with Owner, Ann MacDonald to review the POCs associated to deficiencies cited on 11/20/19: Today, LPA verified the following:
  • Staff #1 has completed an LIC 503.
  • Staff #1 has completed an LIC 508.
  • Staff #1 has completed an LIC 9052.

LPA cleared deficiencies on this date and provided licensee with a "Letter of Deficiency Citations Cleared." This letter must be filed in the facility for three years and upon request made accessible to the public for review.

No deficiency cited on this date.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
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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