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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371208
Report Date: 05/11/2022
Date Signed: 05/11/2022 09:30:50 AM


Document Has Been Signed on 05/11/2022 09:30 AM - 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:MONTESSORI ACADEMY AT THE RANCHFACILITY NUMBER:
304371208
ADMINISTRATOR:KIM, TAMARA LEWFACILITY TYPE:
850
ADDRESS:74 ESENCIA DRTELEPHONE:
(949) 234-6136
CITY:RANCHO MISSION VIEJOSTATE: CAZIP CODE:
92694
CAPACITY:178CENSUS: 46DATE:
05/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director, Tamara Lew KimTIME COMPLETED:
09:47 AM
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Licensing Program Analyst (LPA) Patricia Rivas conducted an unannounced case management visit to render findings on one incident report provided by facility on 02/23/22,

The Covid-19 Emergency Response questionnaires were asked. A toured the facility was conducted, and a census was taken. Observed at the time of the visit 46 children and 12 teachers throughout the facility.

A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions


The second incident was verbally reported on 02/23/22. It was alleged that S2 hit C2. Date of alleged incident was not provided. LPA interviewed 5 staff who all denied seeing S2 hit C2. Director reports S2 is no longer working at the facility and C2 was not present today no longer attends program.. LPA was unable to interview S2 and C2's parents who did not return telephone calls Based on the information available LPA was unable to corroborate allegation. Preponderance of evidence showing a violation occurred was not found.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022
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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