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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020764
Report Date: 07/13/2022
Date Signed: 07/13/2022 12:29:30 PM

Document Has Been Signed on 07/13/2022 12:29 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MONTESSORI OF WALNUTFACILITY NUMBER:
198020764
ADMINISTRATOR:BISHAN SENEVIRATNEFACILITY TYPE:
830
ADDRESS:20121 E. ALISU CTTELEPHONE:
(909) 598-9267
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY: 18TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Christina GregoryTIME COMPLETED:
12:40 PM
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Case management inspection conducted by Licensing Program Analyst Jennifer Hua. LPA met with Assistant Director Christina Gregory. LPA attempted to conduct an annual required inspection. Per assistant director, the infant program is currently not in operation since January of 2022 and not sure if/when may reopen. LPA explained inactive licensee status and form was provided. Assistant director will relate information to Director.

An exit interview conducted. copy of report given.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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