<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372002147
Report Date: 10/15/2020
Date Signed: 10/15/2020 09:50:37 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MONTESSORI SCHOOL HOUSEFACILITY NUMBER:
372002147
ADMINISTRATOR:DENA STONEMANFACILITY TYPE:
850
ADDRESS:4544 POCAHONTAS AVENUETELEPHONE:
(858) 270-9350
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:77CENSUS: DATE:
10/15/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Director Debra SheehanTIME COMPLETED:
09:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/15/2020 @ 9:38 a.m., LPA conducted a case management Televisit due to Covid-19 restrictions. The purpose of this visit is to deliver an amended LIC 809 and 809C, originally delivered on 10/7/2020.

This report and the amended reports will be delivered via email. Reply to email will serve as confirmation of receipt.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1