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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343628256
Report Date: 08/26/2026
Date Signed: 08/26/2026 04:15:44 PM

Document Has Been Signed on 08/26/2026 04:15 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MONTESSORI PLAYSCHOOLFACILITY NUMBER:
343628256
ADMINISTRATOR/
DIRECTOR:		BOYKO, NATALIAFACILITY TYPE:
860
ADDRESS:2925 Root AVETELEPHONE:
(916) 470-6898
CITY:CarmichaelSTATE: CAZIP CODE:
956083536
CAPACITY: 45TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/26/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Natalia BoykoTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On August 26, 2026 at approximately 12:30 PM, Licensing Program Analyst (LPA), Josiah Gathing met with Licensee Representative (LR) Natalia Boyko for an announced Pre-Licensing inspection. LR is requesting a license for 15 infants (ages 0 to 24 months) in the Infant Room 1 and Infant Room 2; 12 Preschool children (ages 2 years-kindergarten) in Preschool Room; and 18 School-Age children (ages K-9th grade) in the School-Age Room. LR originally requested infant capacity 15, preschool capacity 18, and school-age capacity 12, but requested changes to preschool and school-age capacities during today's inspection due to limited preschool square footage. The total requested capacity is 45 children. Areas of the facility not included in indoor activity space include Staff and Children's Restrooms, Kitchen, Office, and Storage Room. Hours of operation will be: Monday-Saturday 7:00AM-10:00PM.

All indoor and outdoor activity space utilized for the children was inspected today. LPA informed LR that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, LR stated that they will be stored according to regulation in the kitchen, inaccessible to children. A fully equipped first aid kit is stored in each classroom. There are dual smoke and carbon monoxide detectors in the classrooms. All required licensing documents were observed posted near the entrance to the preschool, infant, and school-age areas. Children will be signed in and out via paper sign-in folders in each classroom.




Cont. on LIC809-C...
Belinda Devall
Josiah Gathing
DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2026
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MONTESSORI PLAYSCHOOL
FACILITY NUMBER: 343628256
VISIT DATE: 08/26/2026
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LPA measured total indoor infant activity space of 678.1982 square feet, which is sufficient to accommodate the requested capacity of 15 infants. LPA measured total indoor preschool activity space of 453.333 square feet, which is sufficient to accommodate the requested capacity of 12 preschool children. LPA measured total indoor school-age activity space of 745.65 square feet which is sufficient to accommodate the requested capacity of 18 school-age children.

LPA observed all indoor activity space to be complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, mats, cots, cribs, bookshelves, and other activity supplies for the children. Toys are safe with no sharp edges, splinters, or points, nor made of small parts that can present a choking hazard. Drinking water is available in the classrooms via containers provided by parents and disposable bottles provided by the facility. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. The fire department provided an approved fire clearance form to Licensing on 7/21/2026. LPA submitted updated fire clearance request showing new preschool and school-age capacity during today's inspection.

LPA observed two changing tables, one in infant room 1, one in the preschool restroom. Changing tables have at least 1” padding covered with moisture-resistant, washable material. Sides of the changing tables are at least 3” high. There are sinks within arm's reach of the changing tables. Diapering sinks are not used for meal preparation or dishwashing. The infant napping area is physically separated from the indoor activity space according to regulation. During today's inspection, there were 4 cribs meeting regulatory requirements in the infant napping area. LPA advised LR that the number of infants enrolled who require cribs must never exceed the number of available cribs in the nap area. Sleep Logs and Needs and Services Plans will be kept in the infant room.

There are 6 toilets and 6 sinks available to children which will accommodate the requested capacity of 45. There is a staff restroom equipped with a toilet and sink. The isolation area for children who are ill will be the office.

The facility will provide Breakfast, Snack, Lunch, and Dinner. Additional snacks are provided by parents/guardians. There is a refrigerator in the kitchen and a miniature refrigerator in Infant Room 1 to store milk and formula. Hazardous solutions and cleaning supplies are kept in the kitchen.


Cont. on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MONTESSORI PLAYSCHOOL
FACILITY NUMBER: 343628256
VISIT DATE: 08/26/2026
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The facility currently has two fully fenced playground areas. Fencing is at least four feet high. LPA measured total square footage of 4,089.95 for the outdoor infant activity space, which is sufficient to accommodate the requested capacity of 15 infants. The total square footage for the outdoor preschool space is 6,105.35 which is sufficient to accommodate the requested capacity of 12 preschoolers. LPA measured total square footage of 2,237.76 for the outdoor school-age activity space, which is sufficient to accommodate the requested capacity of 18 school-age children.

There are sufficient outdoor toys and play equipment available on the playgrounds. LPA reminded LR to ensure that all play equipment and structures are only utilized by appropriate age groups. Drinking water is available outdoors via containers provided by parents and disposable bottles provided by the facility.

LR was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LR was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child

LR was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Cont. on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MONTESSORI PLAYSCHOOL
FACILITY NUMBER: 343628256
VISIT DATE: 08/26/2026
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Exit interview conducted and report was reviewed with LR, Natalia Boyko.

The following corrections are needed prior to the issuance of the license:

-Updated licensing documents to reflect the new capacities:


- LIC 200A
- Family Handbooks (Preschool/School-age and Infant)
- Schedule of Daily Activities (Preschool and School-Age)
-Updated fire clearance document with new capacities.
-Submission of any additional requested documents.
-Final review and approval by Licensing Program Manager.

LR understands that all proof of corrections must be provided to the department within 30 days, or the application may be denied.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026
LIC809 (FAS) - (06/04)
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