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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701528
Report Date: 09/06/2022
Date Signed: 09/06/2022 11:41:50 AM

Document Has Been Signed on 09/06/2022 11:41 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MY MONTESSORI SCHOOL CORONADO, LLCFACILITY NUMBER:
376701528
ADMINISTRATOR:GILBERTO HERNANDEZFACILITY TYPE:
850
ADDRESS:1123 8TH STREETTELEPHONE:
(619) 870-6459
CITY:CORONADOSTATE: CAZIP CODE:
92118
CAPACITY: 36TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/06/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Gilberto Hernandez TIME COMPLETED:
11:30 AM
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On 09/06/22 at 8:30 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an announced office meeting and met with Applicant, Gilberto Hernandez. The purpose of today's meeting is to review the pending documents listed on the LIC184 - Notice of Incomplete Application Checklist.

LPA reviewed and discussed the pending documents in detail with Applicant, Gilberto Hernandez. LPA provided cdss.ca.gov and other resources to applicant. Applicant acknowledged understanding of the remaining pending documents.

A copy of this report was reviewed and provided during today's visit.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2022
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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