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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619934
Report Date: 09/05/2019
Date Signed: 09/05/2019 11:14:47 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:ELK GROVE MONTESSORI SCHOOL (PS)FACILITY NUMBER:
343619934
ADMINISTRATOR:NELSON, SARAFACILITY TYPE:
850
ADDRESS:8842 WILLIAMSON DRIVETELEPHONE:
(916) 685-6540
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:107CENSUS: 60DATE:
09/05/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sara NelsonTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Amy Silva and Seychelle De Luca conducted an unannounced case management visit and met with Program Director, Sara Nelson. The purpose of today’s visit was to amend a complaint inspection report, originally delivered to the Program Director on 7/22/19.

No deficiencies cited and exit interview was conducted. Notice of site visit was provided and posted.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
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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