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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001552
Report Date: 02/06/2023
Date Signed: 02/21/2023 11:28:29 AM

Document Has Been Signed on 02/21/2023 11:28 AM - 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: 70DATE:
02/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Judy Krause TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced case management inspection. Upon arrival LPA Lee met with Executive Director Judy Krause.

The purpose of the inspection was to obtain additional information regarding an incident that occurred at the facility on 01/10/2023. The department was made aware of the incident from an incident report submitted by the facility on 01/11/2023.

During the inspection LPA Lee conducted interviews, reviewed documents, and made observations regarding the incident that occurred at the facility on 01/10/2023. At this time LPA Lee did not find deficiencies to cite during the inspection.

The notice of site inspection must remain posted for a period of 30 days during hours of operation. Failure to maintain posting will result in a civil penalty of $100.00 dollars.

Exit interview conducted with Director Judy Krause. Appeal rights discussed and explained.
Guangorena Claudia
Seung Lee
DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
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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