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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313619751
Report Date: 01/25/2023
Date Signed: 01/25/2023 12:43:17 PM


Document Has Been Signed on 01/25/2023 12:43 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:AMERICAN MONTESSORI ACADEMYFACILITY NUMBER:
313619751
ADMINISTRATOR:WISE, MICHELLEFACILITY TYPE:
850
ADDRESS:1050 DOUGLAS BLVDTELEPHONE:
(916) 786-3636
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:128CENSUS: 31DATE:
01/25/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Michelle Wise - DirectorTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst Katrina Owens met with Director Michelle Wise to conduct an unannounced case management inspection regarding lead testing. During today's inspection there were 31 preschool children and 7 staff; in three classrooms.

The purpose of today's inspection was to cite the facility for not having their water tested for lead by January 1, 2023.; according to Assembly Bill 2370, which requires licensed Child Care facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1st, 2020 to January 1st, 2023 and must be conducted every five years from initial testing.

Deficiencies are cited on next page 809-D

An exit interview was conducted with Director. Appeal Rights were given.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
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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Document Has Been Signed on 01/25/2023 12:43 PM - It Cannot Be Edited

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: AMERICAN MONTESSORI ACADEMY
FACILITY NUMBER: 313619751

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2023
Section Cited

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California Lead Action Level at Child Care Center (b) Testing results with (1)A values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced
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Director stated the owner has the a leading testing scheduled for February 15, 2023. The delay was due to no available appointments sooner.
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by the facility has not gotten their water tested for lead according to Assembly Bill 2370 by January 1, 2023.
This is a potential risk to children.
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Facility stated they will be applying for a lead testing waiver.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
LIC809 (FAS) - (06/04)
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