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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614059
Report Date: 01/10/2020
Date Signed: 01/15/2020 12:45:14 PM

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:
343614059
ADMINISTRATOR:PHILLIPS, FELICIAFACILITY TYPE:
850
ADDRESS:2075 ARENA BLVDTELEPHONE:
(916) 515-0550
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:165CENSUS: 88DATE:
01/10/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Lucky and Sue RanatungaTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Christopher Bello and Mai Lor arrived at the facility regarding an incident that occurred on 1/3/2020. LPAs met with Administrator Lucky Ranatunga and Program Director Sue Ranatunga. LPAs conducted interviews and made observations regarding the incident.

Lucky and Sue stated that they believe that the child would have cried if an incident like that occurred in their facility. Lucky and Sue also stated that staff stated that they did not witness this event take place. Lucky and Sue stated that they are re-evaluating how the staff are watching the play yard.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the administrator and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the director understands it must remain posted for 30 days.


*AMENDED REPORT*
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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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