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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700964
Report Date: 07/14/2023
Date Signed: 07/14/2023 12:25:45 PM

Document Has Been Signed on 07/14/2023 12:25 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:VILLAGE MONTESSORI SCHOOLFACILITY NUMBER:
376700964
ADMINISTRATOR:PETRA WOODFACILITY TYPE:
850
ADDRESS:2606 JEFFERSON STREETTELEPHONE:
(760) 637-5113
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: 16TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Shelby AnayaTIME COMPLETED:
12:45 PM
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On 07/14/2023 at 9:15am, Licensing Program Analyst (LPA) Samantha Clenista conducted an unannounced case management inspection. Upon arrival, LPA met with newly hired Director, Shelby Anaya, and proceeded to tour the facility. No children were present. All required notices, forms and license were posted upon entry of the facility. Purpose of this visit is to complete LPA's initial inspection dated 07/06/23 and deliver inspection report and Notice of Site Visits. The inspection and reports were not completed and delivered during the 07/06/23 inspection due to LPA undergoing a personal emergency and had to leave abruptly.

An exit interview was conducted was Ms. Anaya. This report was reviewed and provided to Ms. Anaya. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2023
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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