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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343613062
Report Date: 07/29/2019
Date Signed: 07/29/2019 09:41:03 AM

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:LITTLE BLOSSOM MONTESSORI SCHOOL, INC.FACILITY NUMBER:
343613062
ADMINISTRATOR:CHAYA SENARATH, GALLOLUWEFACILITY TYPE:
830
ADDRESS:2075 ARENA BLVD.TELEPHONE:
(916) 515-0550
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:40CENSUS: DATE:
07/29/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Lucky RanatungaTIME COMPLETED:
10:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility for a Case Management – Deficiencies Inspection to clear the deficiency regarding Teacher-Child Ratios cited on 7/26/19. LPA Bello observed the Infant and Toddler facilities and observed that both rooms were in Teacher-Child Ratios. LPA cleared the deficiency.

There were no Title 22 deficiencies during today’s investigation. An exit interview was conducted and a Notice of Site Visit posted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
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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