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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015307
Report Date: 10/15/2019
Date Signed: 10/15/2019 01:31:00 PM

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:COLONIAL HOUSE PRESCHOOLFACILITY NUMBER:
198015307
ADMINISTRATOR:MELANIE NYEHOLTFACILITY TYPE:
850
ADDRESS:1124 MISSION STREETTELEPHONE:
(626) 403-6554
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY:60CENSUS: 40DATE:
10/15/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sara GarridoTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced case management inspection. Upon arrival LPA Lee met with Office Manager Sara Garrido.

The purpose of the inspection was to obtain additional information regarding an incident report submitted to the department on 08/09/2019. Child#1 had an allergic reaction during lunch time and had to be administered with medication at the facility. The facility has a written IMS policy as part of its parent handbook. Copy of these procedures for providing IMS services was provided by the facility.

During the inspection, LPA Lee obtained information regarding a prior incident that occurred on 03/22/2019. During pick up time, facility staff observed the Nanny of Child#2 violate the personal rights of the child in the presence of other children in care. Facility notified the parent of Child#2 and the written child abuse reporting procedure was followed.

Based on the information collected during this inspection there were no deficiencies cited for the two incidents on this date.

The notice of site inspection must remain posted for 30 days during hours of operation. Failure to maintain posting will result in a civil penalty of $100.00 dollars. Exit interview conducted with Office Manager Sara Garrido. Appeal rights discussed and explained.
SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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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