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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093622019
Report Date: 01/07/2022
Date Signed: 01/07/2022 12:05:01 PM

Document Has Been Signed on 01/07/2022 12:05 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: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: 56CENSUS: 21DATE:
01/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Kimberly BeemanTIME COMPLETED:
12:10 PM
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LPA Martinez and Lor conducted a visit and met with the licensee Kimberly Beeman. Today's visit was to remove the toddler component from the preschool license and inspect the infant license to ensure the toddler option could be added to the rooms. During todays inspection the preschool room was inspected and ready to be used.

Notice of site visit must be posted for 30 days. No citations were issued.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Mikah Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2022
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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