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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700060
Report Date: 11/12/2021
Date Signed: 11/12/2021 10:27:12 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MONTESSORI SCHOOL OF OCEANSIDE #2 - INFANTFACILITY NUMBER:
376700060
ADMINISTRATOR:MENDOZA, SYLVIAFACILITY TYPE:
830
ADDRESS:4760 OCEANSIDE BLVD., #B10TELEPHONE:
(760) 724-8955
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:22CENSUS: 14DATE:
11/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Director Sylvia MendozaTIME COMPLETED:
10:42 AM
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LPA Otsanya Cameron arrived at the above facility in order to conduct a Case Management visit.
Due to FAS consistency check, signatures for report dated on 11/10/21 were not saved.

No citation were issued in todays visit.

An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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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