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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011204
Report Date: 09/22/2023
Date Signed: 09/22/2023 10:21:51 AM

Document Has Been Signed on 09/22/2023 10:21 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:INTERNATIONAL MONTESSORI PRESCHOOLFACILITY NUMBER:
198011204
ADMINISTRATOR:LAURIE SEGURAFACILITY TYPE:
850
ADDRESS:211 E. ARROW HWYTELEPHONE:
(909) 399-9222
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 48TOTAL ENROLLED CHILDREN: 26CENSUS: 12DATE:
09/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Wendy MitchellTIME COMPLETED:
10:15 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 9/22/2023 Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced Case Management visit to amend page 1 of LIC 809 report dated 9/20/2023 to correct information provided on the initial report given during the Case Management Incident inspection. A Covid Risk assessment had been conducted. LPA met with Licensee, Wendy Mitchell who guided LPA on a tour and took a census of 12 children and 2 staff members present at the time of visit.

LPA consulted with Licensee with regards to the facility.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Wendy Mitchell.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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