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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240403488
Report Date: 10/21/2024
Date Signed: 10/21/2024 12:39:33 PM

Document Has Been Signed on 10/21/2024 12:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MERCED MONTESSORI SCHOOLFACILITY NUMBER:
240403488
ADMINISTRATOR/
DIRECTOR:		MACDONALD ANNFACILITY TYPE:
850
ADDRESS:424 W 21ST STREETTELEPHONE:
(209) 722-9823
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 22DATE:
10/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Ann MacDonaldTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 10/21/24, Licensing Program Analyst (LPA) Priscilla Zamudio conducted an unannounced case management inspection. LPA met with Licensee, Ann MacDonald to discuss an incident which occurred on 9/10/24 and a census was also taken. LPA interviewed staff, reviewed pertinent information and observed where the incident occurred.

On 9/10/24, at approximately 4:30pm, child #1 was walking up steps of play structure and another child pushed him. Child#1 fell on his shoulder. Director MacDonald stated she was in close proximity to the child but was unable to keep from falling. Child#1 was taken to hospital the following day and informed there were no broken bones. Staff talked to the children about safety on the playground and not pushing friends.

Based on information gathered and observations made by LPA, there were no obvious concerns or hazards found. Staff are implementing adequate care and supervision at the facility.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.

Exit interview conducted and report was reviewed with Licensee, Ann MacDonald.

This report shall be made available to the public upon request. 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.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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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