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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191502478
Report Date: 02/27/2020
Date Signed: 02/27/2020 09:57:56 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ST JAMES PARISH SCHOOLFACILITY NUMBER:
191502478
ADMINISTRATOR:KIM GOODRICHFACILITY TYPE:
850
ADDRESS:1325 MONTEREY ROADTELEPHONE:
(626) 799-6906
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY:90CENSUS: 64DATE:
02/27/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Kim Goodrich TIME COMPLETED:
10:15 AM
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Licensing Program Analyst's (LPA's) Judy Mora and Nolan Tcheng conducted a subsequent case management inspection to follow up on an incident report that was submitted to the Department on 01/23/20. This is a follow up inspection from 02/05/2020. Licensing staff met with Kim Goodrich, who guided staff on a tour of the facility. In addition to the above incidents, the Department received Unusual Incident Reports on 02/05/2020, 02/19/2020 and 02/24/2020.

Licensing staff conducted interview with Director and documentation was obtained. Based on all information obtained on this date no follow-up is necessary regarding the above incidents. The incidents appear to be unusual accidents. There were no deficiencies observed in regards to today's visit.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Director. Appeal rights explained & provided.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
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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