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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842076
Report Date: 06/01/2023
Date Signed: 06/01/2023 02:44:26 PM

Document Has Been Signed on 06/01/2023 02:44 PM - It Cannot Be Edited

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:ST. MARY'S MONTESSORI SCHOOLFACILITY NUMBER:
364842076
ADMINISTRATOR:MARTINEZ DESERIEFACILITY TYPE:
830
ADDRESS:6880 N VICTORIA WINDROWS LOOPTELEPHONE:
(909) 200-2727
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 17DATE:
06/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Emily Turner/AdministratorTIME COMPLETED:
03:15 PM
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On 6/1/23 at 1:50 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a case management visit to deliver a Decision and Order (DO) for Adult #1. LPA was granted access into the facility and met with the director. LPA toured facility and took a census.

LPA observed Adult #1 was not present in the facility.

LPA discussed the DO with the administrator and administrator understands Adult #1 cannot be in the building at anytime.


Exit interview conducted with the administrator, report, appeal rights and notice of site visit issued.


Notice of site visit must be posted for 30 days.

LIC 811 Confidential names list provided to administrator.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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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