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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015307
Report Date: 11/01/2022
Date Signed: 11/01/2022 10:09:14 AM

Document Has Been Signed on 11/01/2022 10:09 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:COLONIAL HOUSE PRESCHOOLFACILITY NUMBER:
198015307
ADMINISTRATOR:JOANNA HAWKINSFACILITY TYPE:
850
ADDRESS:1124 MISSION STREETTELEPHONE:
(626) 403-6554
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 28DATE:
11/01/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Site Supervisor, Sara GarridoTIME COMPLETED:
10:15 AM
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An unannounced Case Management Annual Continuation visit was conducted by Licensing Program Analyst (LPA), Bardo Baluyot for the purpose of reviewing staff files. Files were not available during the initial visit conducted on 10/19/22 as Director's office where files were stored was inaccessible. Supervisor had to leave unexpectedly to tend to personal matters . LPA met with Site Supervisor, Sara Garrido.

Staff records were reviewed and found to be complete.
There were no deficiencies observed on this date in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes.

Exit interview was conducted with Supervisor. Appeal rights and procedures explained.

A copy of this report was provided.

Visit: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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