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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845472
Report Date: 10/07/2021
Date Signed: 10/08/2021 11:36:45 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:MONTESSORI ACADEMY OF UPLANDFACILITY NUMBER:
364845472
ADMINISTRATOR:THEWES, ADAMFACILITY TYPE:
830
ADDRESS:934 N. MOUNTAIN AVENUETELEPHONE:
(909) 621-1603
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:16CENSUS: 7DATE:
10/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:18 PM
MET WITH:Kris ThewesTIME COMPLETED:
07:49 PM
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Licensing Program Analyst (LPA) Kim Leung conducted a case management visit on the preschool program this date on 10/7/2021. During the inspection, LPA took census in the infant room and verified criminal record clearances.

No deficiency was cited during this inspection.

An exit interview was conducted with administrator Kris Thewes. A Notice of Site visit was issued and must be posted for 30 days.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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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