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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093622019
Report Date: 04/27/2021
Date Signed: 04/28/2021 07:31:36 AM

Document Has Been Signed on 04/28/2021 07:31 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CAMERON PARK MONTESSORI SCHOOL, INC.FACILITY NUMBER:
093622019
ADMINISTRATOR:BEEMAN, KIMBERLY ANNEFACILITY TYPE:
850
ADDRESS:4140 MOTHERLODE DR. SUITE 100TELEPHONE:
(530) 677-1776
CITY:SHINGLE SPRINGSSTATE: CAZIP CODE:
95682
CAPACITY: 56TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/27/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Kimberly BeemanTIME COMPLETED:
05:30 PM
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On 4/27/21 at 5:00pm, Licensing Program Analysts (LPA), Jan Hoshida, met with Director/Owner, Kimberly Beeman, for the purpose of a case management inspection to inspect the new extension of the outdoor playground area. Due to the COVID-19 pandemic, LPA conducted the inspection via FaceTime with Director/Owner. There were no day care children present.

The preschool recently extended the outdoor playground area by about five feet. Director/Owner informed LPA of the proposed outdoor playground area on 4/14/21. LPA requested to inspect the playground and observed that the chain-linked fence was moved, the poles of the fence were secure in the ground and previous holes were covered up. Director/Owner stated that she will be moving the turf on the ground to be closer to the fence line. LPA observed that the new space of the outdoor playground area meets Title 22 safety regulations and that it is safe for children to use effective today. LPA did not re-measure the outdoor playground area at this time.

An Exit Interview was conducted in which the report was reviewed and discussed with Director. A Notice of Site Visit was provided via email and should remain posted for 30 days. Facility evaluation report was emailed to Director and an email verification of receipt of report will be used in lieu of a signature on this report.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2021
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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