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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844868
Report Date: 01/11/2022
Date Signed: 01/11/2022 12:23:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MONTESSORI SCHOOL OF CORONAFACILITY NUMBER:
334844868
ADMINISTRATOR:VARMA, MAHIMAFACILITY TYPE:
850
ADDRESS:260 W. ONTARIO AVENUETELEPHONE:
(951) 371-6731
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:120CENSUS: 70DATE:
01/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Licensee , Mahima Varma, and Administrator Sandra PerezTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Blanca Ruiz arrived at the facility to conduct a case management inspection in response to the receipt of an unusual incident report (UIR). The incident occurred on 01/07/2022 and submitted by the facility on 01/11/2022. At the time of inspection, LPA met with Licensee, Mahima Varma and Administrator, Sandra Perez. LPA toured the facility and took census.

During the inspection, files were reviewed and documents pertinent to the incident were obtained. Additional investigation will be conducted by Community Care Licensing Investigations Branch, Investigator, Wilfredo Vasquez.



An exit interview was conducted with Licensee, Mahima Varma and Administrator, Sandra Perez. A Notice of Site visit was issued, along with a copy of this report.

A copy of this report must be made available to the public, at the facility site, for 3 years.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022
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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