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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570306190
Report Date: 10/22/2024
Date Signed: 10/22/2024 01:09:01 PM

Document Has Been Signed on 10/22/2024 01:09 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MONTESSORI COUNTRY DAYFACILITY NUMBER:
570306190
ADMINISTRATOR/
DIRECTOR:		ROBERTSON, DEBBIEFACILITY TYPE:
850
ADDRESS:1811 RENOIRTELEPHONE:
(530) 753-8373
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 29DATE:
10/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Director, Debbie RobertsonTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Lauren Scott met with director, Debbie Robertson to follow up on an Unusual Incident Report (UIR) that was reported to Community Care Licensing on 09/11/2024.

The facility reported the UIR to Community Care Licensing within 24hrs and were reminded to submit a written UIR was submitted within 7 days. LPA reviewed and discussed the incident with the director.

Facility evaluation report was reviewed and discussed with the director. An exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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