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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300575
Report Date: 04/25/2023
Date Signed: 04/25/2023 09:40:01 AM

Document Has Been Signed on 04/25/2023 09:40 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:BRIGHT MINDS MONTESSORI,INC.FACILITY NUMBER:
336300575
ADMINISTRATOR:DE SILVA, CHAMALIFACILITY TYPE:
850
ADDRESS:17159 GRAND AVETELEPHONE:
(951) 378-4103
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/25/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Nam De Silva TIME COMPLETED:
09:50 AM
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 Licensing Program Analyst (LPA) Ana Noble arrived at the facility for the purpose of verifying, and ensuring the facility is ready for Licensure due to a lapse in time between last inspection for plan of Corrections for Preschool Program. LPA met with Applicant Nam De Silva, toured the entire facility which included Preschool and School Age.

Limiting factor is request capacity. The Fire Clearance granted on 11/8/2022.
Preschool capacity is limited to 12 children.

License will be submitted for approval effective 4/26/2023.

Exit interview conducted and reports were reviewed and provided to De Silva-Applicant. All reports must be maintained for 3 years and kept available for review upon request.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2023
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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