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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340315188
Report Date: 08/05/2021
Date Signed: 08/05/2021 03:27:16 PM

Document Has Been Signed on 08/05/2021 03:27 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:VILLAGE MONTESSORI SCHOOLFACILITY NUMBER:
340315188
ADMINISTRATOR:WILLIS, LISA/AUERING, ERINFACILITY TYPE:
850
ADDRESS:5033 FAIR OAKS BLVDTELEPHONE:
(916) 488-6500
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 128TOTAL ENROLLED CHILDREN: 0CENSUS: 34DATE:
08/05/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Erin AueringTIME COMPLETED:
03:40 PM
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At 1:40 p.m. on Thursday, August 5th, 2021, Licensing Program Analyst (LPA) Karyn Guerra met with Director, Erin Auernig, to conduct a POC inspection regarding a citation dated on 07/19/2021. At time of arrival, LPA observed a census of 34 children supervised by 8 staff. The facility was previously cited for buildings and grounds for the self latching device on the gate of the swimming pool being greater than 6 inches from the top of the fence. LPA observed the corrected gate with self latching device within 6 inches from the top of the fence. Building and grounds citation has been corrected per POC and has been cleared.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2021
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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