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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845818
Report Date: 11/08/2022
Date Signed: 11/08/2022 03:36:37 PM

Document Has Been Signed on 11/08/2022 03:36 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LITTLE STEPS MONTESSORI PRESCHOOL SCHOOL AGEFACILITY NUMBER:
334845818
ADMINISTRATOR:JENNIFER FERNANDOFACILITY TYPE:
840
ADDRESS:6316 WINEVILLE AVE.TELEPHONE:
(951) 737-7845
CITY:MIRA LOMASTATE: CAZIP CODE:
91752
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
11/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Jennifer FernandoTIME COMPLETED:
03:40 PM
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On 11/08/22 at 02:45 PM, a case management visit was completed by Licensing Program Analyst (LPA) Giselle Carbullido to conduct children interviews in the course of another inspection at another facility. LPA was granted entry by Director, Jennifer Fernando. LPA toured the facility, and took census.

An exit interview was conducted, a copy of this report, appeal rights and Notice of Site Visit was provided to the Director; and the LPA observed the Notice of Site Visit form was posted. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022
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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