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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001552
Report Date: 02/25/2022
Date Signed: 02/25/2022 12:00:08 PM

Document Has Been Signed on 02/25/2022 12:00 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PACIFIC OAKS CHILDREN'S SCHOOLFACILITY NUMBER:
198001552
ADMINISTRATOR:ROBERT BOYMANFACILITY TYPE:
850
ADDRESS:714 W. CALIFORNIA BLVD.TELEPHONE:
(626) 529-8011
CITY:PASADENASTATE: CAZIP CODE:
91105
CAPACITY: 140TOTAL ENROLLED CHILDREN: 140CENSUS: 95DATE:
02/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Judy Krause, DirectorTIME COMPLETED:
12:00 PM
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On 02/25/22 Licensing Program Analyst (LPA) Fabiola Vasquez conducted an unannounced case management inspection due to an incident that occurred on 12/03/21 and 12/07/21. LPA met with Judy Krause, Director, who guided LPA on a tour of the facility.

There were 95 children and 21 staff present upon arrival.

LPA Vasquez conducted interviews and obtained documentation during this visit.

The incident that occurred on 12/03/22 and 12/07/21. Was reported to the Department on 12/07/21, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

It was alleged that Staff # 1 was going to tickle Child (C)1, and C2 on 12/03/21 and the incident that occurred with an upset parent on 12/07/21.

Based on all information obtained on this date, and interviews conducted with Child # 1, Staff # (S) S1, S2, S3, S4, and Director, there were no disclosures made indicating that a children were tickled. There is no follow up is necessary regarding the incident.

There were no deficiencies cited on this date.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days. Exit interview was conducted with Judy Krause, Director, including, but not limited to Provider Rights, Appeal Procedures

Claudia Guangorena
Fabiola Vasquez
DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
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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