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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845750
Report Date: 10/17/2022
Date Signed: 10/17/2022 10:33:54 AM

Document Has Been Signed on 10/17/2022 10:33 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:RIVERSIDE MONTESSORI ACADEMYFACILITY NUMBER:
334845750
ADMINISTRATOR:RADIKA RATNAYAKEFACILITY TYPE:
850
ADDRESS:7141 INDIANA AVETELEPHONE:
(951) 686-1335
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 46DATE:
10/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Radika Ratnayake, DirectorTIME COMPLETED:
10:35 AM
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On the date and time above, Licensing Program Analyst (LPA) Kay Turner arrived at the facility on a case management visit to follow-up on an unusual incident report submitted by the facility on September 29, 2022. At the time of visit, LPA toured the facility (specifically were the reported incident took place), took census, and met with Director - Radika Ratnayake to discuss the reported incident. During the visit, LPA also spoke with the teachers who witnessed the incident as it took place. The subject children involved in the incident was interviewed by the LPA as well.
Based on the information obtained during the visit, as well as an inspection of the furniture and equipment (photographs of file), there appeared to be no violations of Title 22 Regulations pertaining to the reported incident. LPA will follow-up with the parent of the injured child.

An exit interview was held with Program Coordinator, Tyra Moody. A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2022
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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