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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 12:01:54 PM

Document Has Been Signed on 02/25/2022 12:01 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:
12:00 PM
MET WITH:Judy Krause, DirectorTIME COMPLETED:
12:30 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 02/10/22. 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 02/10/22. Was reported to the Department on 02/11/20, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that staff# 1 was bending down and poked his eye on a tree branch.

Based upon information received during LPA’s observation during the visit and from the interviews conducted with the director who stated that Maintenance cuts down the branch. It was determined that this was an accident.

There were no deficiencies cited during today’s inspection

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. 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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