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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393600441
Report Date: 10/16/2024
Date Signed: 10/16/2024 10:29:51 AM


Document Has Been Signed on 10/16/2024 10:29 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:MONTESSORI SCHOOL OF TRACYFACILITY NUMBER:
393600441
ADMINISTRATOR:TERESA MORENOFACILITY TYPE:
850
ADDRESS:100 SOUTH TRACY BOULEVARDTELEPHONE:
(209) 833-3458
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:240CENSUS: 42DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Teresa Moreno TIME COMPLETED:
10:20 AM
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On October 16, 2024, Licensing Program Analyst (LPA) Stacey Williams met with Director, Teresa Moreno to gain signature for a report generated from an inspection conducted on October 10, 2024. The report on October 10, 2024 read as follows:

On October 10, 2024, Licensing Program Analyst (LPA) Stacey Williams conducted a case management inspection and met with Director, Teresa Moreno. LPA observed (42) children supervised by 8 staff.

LPA discussed an incident report that was submitted to Community Care Licensing on October 7, 2024. LPA conducted staff interviews during the inspection and obtained additional information.

Exit interview conducted and report was reviewed with Director, Teresa Moreno. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024
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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