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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845752
Report Date: 05/29/2024
Date Signed: 05/29/2024 08:50:49 AM

Document Has Been Signed on 05/29/2024 08:50 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:RIVERSIDE MONTESSORI ACADEMYFACILITY NUMBER:
334845752
ADMINISTRATOR/
DIRECTOR:		MARIA AMADORFACILITY TYPE:
850
ADDRESS:6200 PACHAPPA DRTELEPHONE:
(951) 682-3380
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 0DATE:
05/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Amila ChandrapalaTIME VISIT/
INSPECTION COMPLETED:
08:55 AM
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A case management visit is being conducted in response to the receipt of a phone call notifying of the replacement of an outdoor play structure. The phone call was received by the Licensing Program Analyst, LPA Carbullido on 05/23/2024. The phone call indicated the facility completed renovations to the outdoor activity area requiring temporary off limits and implementation of safety measures.
LPA reviewed records and conducted interviews. A tour of the facility was also conducted to verify completed renovations and readiness for use. During the tour, LPA observed and obtained photos of new play structure with wood chips around and underneath.
According to Licensee interview, the facility contracted with Burke for removal of old play structure and addition of new play structure. Interviews noted not being aware of notifying the department (CDSS) prior to renovations to the facility.
Photo review of old play structure and new structure reveal no change to outdoor activity space or square footage. Additional records corroborate a licensed contractor specializing in outdoor equipment was retained.
Based on information gathered, the facility updated the outdoor activity space and took preventative measures (temporary off limits and chain link fence) to ensure the safety of children. Due to facility notifying the department after renovations were implemented and completed, a technical advisory was issued to review Title 22 Division 12 regulation- CCR 101237(a) Alterations to Existing Buildings or New Facilities: (a) Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s).
An exit interview was conducted, and LPA Carbullido provided the Licensee with a copy of this report, appeal rights and notice of site visit during today’s visit.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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