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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343616500
Report Date: 03/22/2022
Date Signed: 03/22/2022 10:14:13 AM

Document Has Been Signed on 03/22/2022 10:14 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:FOLSOM LAKE MONTESSORI ACADEMYFACILITY NUMBER:
343616500
ADMINISTRATOR:KUDUPUDI, UMARAJESWARIFACILITY TYPE:
850
ADDRESS:196 BLUE RAVINE ROADTELEPHONE:
(916) 351-9448
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 33DATE:
03/22/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Uma KudupudiTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Kelly Ferrara conducted a Plan of Correction inspection at the facility and met with Facility Representative Uma Kudupudi. Upon arrival, LPA observed 33 preschool children in care with five staff.

On March 2nd 2022, LPA issued the following citation: Heath and Safety Code 1596.8662(b)(1) regarding the Mandated Reporter training certificate missing for staff. During today's inspection, LPA reviewed staff files and observed that all staff have completed the Mandated Reporter training and are now current. LPA advised Facility Representative that it must be completed every two years.

LPA was able to clear the citation and provide letter as proof.

There were no deficiencies cited based on today's inspection. LPA provided a Notice of Site visit that must remain posted for 30 days for parental review.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2022
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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