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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371203
Report Date: 03/03/2022
Date Signed: 03/03/2022 04:36:55 PM


Document Has Been Signed on 03/03/2022 04:36 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:LIMAI MONTESSORI ACADEMYFACILITY NUMBER:
304371203
ADMINISTRATOR:FAZREEN SHARIFFFACILITY TYPE:
850
ADDRESS:5309 BEACH BLVDTELEPHONE:
(714) 690-0112
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:139CENSUS: 64DATE:
03/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Amy ParkTIME COMPLETED:
05:00 PM
NARRATIVE
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A Case Management visit was conducted to amend the 9099 report for visit conducted on 1/4/22 to obtain signatures, and deliver the amended report (LIC 9099) to facility representative. Census was taken. There were 64 children and 9 staff upon arrival. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 7:30a.m.- 6p.m., Monday through Friday.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA Gontarek met with facility representative, Amy Park and reviewed the amended report. The amended report supersedes the previous report, and the amended report is to be kept in facility files for 3 years.

An exit interview was completed with Amy Park, facility representative. The LIC 809 report was reviewed and discussed with the Assistant Director. The Assistant Director was provided a copy of the appeal rights (LIC 9058 12/15) and the Assistant Director’s signature on this form acknowledges receipt of these rights. A "Notice of Site Visit" was issued. Notice of Site Visit must remain posted for 30 days. Failure to do so will result in a $100.00 civil penalty.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
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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