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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010437
Report Date: 09/17/2024
Date Signed: 09/17/2024 04:56:10 PM

Document Has Been Signed on 09/17/2024 04:56 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:FAIRFIELD MONTESSORIFACILITY NUMBER:
483010437
ADMINISTRATOR/
DIRECTOR:		KUMAR, UMA DEVIFACILITY TYPE:
850
ADDRESS:1101 UTAH STREETTELEPHONE:
(707) 427-1442
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: DATE:
09/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Center director MonikaTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analyst ( LPA) Elpidia Hernandez Torres was at the facility today to conduct an inspection. While present at the facility, Center director had additional questions about staff qualifications, as well as the possibility of increasing or adding younger aged children to the license. Licensee reported she was interested in having infants at the site. LPA was able to read and explain an email licensee received from the CAB ( Centrliazed Application Unit) which had information regarding building codes.

LPA advised the licensee to communicate with the local fire department about the building codes and what would be needed in the future if she did decide to add infants to the license.

LPA reviewed staff records and gave licensee a list of items needed if she wanted other staff to become center director.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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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