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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
304371685
Report Date:
06/19/2024
Date Signed:
06/19/2024 09:18:54 AM
Document Has Been Signed on
06/19/2024 09:18 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
ORANGE COUNTY CC RO
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
MONTESSORI SCHOOL OF SAN CLEMENTE
FACILITY NUMBER:
304371685
ADMINISTRATOR/
DIRECTOR:
WANG, JESSY ZENG
FACILITY TYPE:
860
ADDRESS:
1141 PUERTA DEL SOL
TELEPHONE:
(949) 276-4160
CITY:
SAN CLEMENTE
STATE:
CA
ZIP CODE:
92673
CAPACITY:
189
TOTAL ENROLLED CHILDREN:
189
CENSUS:
0
DATE:
06/19/2024
TYPE OF VISIT:
Office
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:
Jessy Zeng Weng, Applicant
TIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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LPA P Rivas conducted an office meeting to collect and review corrections needed based on notice of incomplete application dated 06/13/24. Ms. Wang has provided all missing documents.
Facility will be licensed effective this date.
SUPERVISORS NAME
:
Monica Cuddy
LICENSING EVALUATOR NAME
:
Pat Rivas
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/19/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/19/2024
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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