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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619934
Report Date: 01/03/2020
Date Signed: 01/03/2020 11:25:50 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: 52DATE:
01/03/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sara NelsonTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Amy Silva conducted an unannounced case management visit and met with Program Director, Sara Nelson. The purpose of today’s visit was to follow up on facility personnel files and to obtain the current LIC500 (Personnel Record). Upon arrival, LPA observed 52 children present with seven staff.

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: 01/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020
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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