Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540405030
Report Date: 08/11/2016
Date Signed 08/11/2016 02:47:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:GREENHOUSE MONTESSORI SCHOOLFACILITY NUMBER:
540405030
ADMINISTRATOR:HOFFMAN, ANNEFACILITY TYPE:
850
ADDRESS:4143 S. DANS LANETELEPHONE:
(559) 625-8385
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:82CENSUS: DATE:
08/11/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Nina Clancy, DirectorTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs), Norma Lomeli and Carmen Sastre conducted an unannounced case management visit on this date to amend a POC date from 8/4/2016 to 8/6/2016 for a Type A violation issued on 8/5/2016.

During exit interview LPA observed Director, Nina Clancy post the Notice the Site Visit report for 30 days where parents may easily view; thereafter, file at the facility with this report for three (3) years for the public review upon request.



As per California Title 22 regulations, no deficiency was cited on this date.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)243-8103
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)243 -8416
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2016
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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