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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845659
Report Date: 12/27/2021
Date Signed: 12/27/2021 03:06:58 PM

Document Has Been Signed on 12/27/2021 03:06 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:NADIA'S MONTESSORI CHILD CAREFACILITY NUMBER:
364845659
ADMINISTRATOR:NADIA AMIR AHMEDFACILITY TYPE:
850
ADDRESS:5001 RIVERSIDE DR.TELEPHONE:
(909) 964-0442
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY: 67TOTAL ENROLLED CHILDREN: 67CENSUS: 22DATE:
12/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Aniemonnet Silan, DirectorTIME COMPLETED:
03:10 PM
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On December 27, 2021, Licensing Program Analysts (LPAs) Giselle Carbullido and Kay Phillips, toured the facility during the course of another investigation. The LPAs observed the following:
1) Cleaning supplies and hand sanitizer accessible to the children in care in Room 5 LIC 9102TV;
2) Children in the classrooms without masks LIC 9102TA.

An exit interview was conducted and a copy of this report, appeal rights and notice of site visit was provided to the Director, Aniemonnet Silan.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2021
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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