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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843031
Report Date: 10/14/2019
Date Signed: 10/14/2019 09:41:31 AM

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 SCHOOL - FONTANAFACILITY NUMBER:
364843031
ADMINISTRATOR:CLAIRE J. GUEVARRAFACILITY TYPE:
850
ADDRESS:7370 W. LIBERTY PARKWAYTELEPHONE:
(909) 200-4747
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:129CENSUS: 114DATE:
10/14/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Justine GuevarraTIME COMPLETED:
09:55 AM
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Licensing Program Analyst, Marlene Wong, conducted a case management visit regarding an Unusual Incident Report (UIR) from the facility. The UIR was received by the licensing agency on 10/03/19. Analyst met with Justine Guevarra, Director to discuss the incident.

On 10/03/19 at 1:56 pm, a fire occurred in the kitchen. Staff called 911 and evacuated the children from the classrooms. When the Fire Department arrived, the fire was contained due to the ansul sprinklers located at the top of the stove's hood. The stove is not operational at this time.

An email was sent to the parents informing them of the fire and the revised menu. Cal Deli delivers food and the cook is going to Sam's Club to pick up weekly products.

Based on information gathered, the facility acted appropriately and no violations have been identified.

An exit interview was conducted and a copy of this report was provided to Ms. Guevarra on this date. A copy of this report must be made available to the public for three years.

Notice of Site Visit was issued and Analyst observed Ms. Guevarra post it.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Marlene WongTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019
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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