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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015307
Report Date: 02/04/2025
Date Signed: 02/04/2025 12:01:50 PM

Document Has Been Signed on 02/04/2025 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:COLONIAL HOUSE PRESCHOOLFACILITY NUMBER:
198015307
ADMINISTRATOR/
DIRECTOR:
JOANNA HAWKINSFACILITY TYPE:
850
ADDRESS:1124 MISSION STREETTELEPHONE:
(626) 403-6554
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 47DATE:
02/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Miranda Perez, TeacherTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On February 4, 2025, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management inspection at the above facility. LPA met with Teacher, Miranda Perez who guided LPA on a tour of the facility. The purpose of the inspection is to follow up on an incident report that occurred on 01/23/2025, and was reported to the department on 01/23/2025. The incident was reported in a timely manner. During the inspection, LPA observed 47 children in care.

The incident is a possible personal rights violation.

During the inspection, LPA interviewed Staff #1 (S1), Child #2 (C2), Staff #2 (S2), obtained a copy of the internal incident report, obtained a copy of the facility roster, and inspected the step stools to ensure they are age appropriate. LPA was unable to interview C1 due to C1 not being qualified. LPA searched the step stools on the internet and showed that the step stools are made for toddler/preschool age children.

Based on record review, observation and interview the above incident appears to be an accident that occurred too rapidly and was unable to be prevented. The facility has placed rubber corners on the corners of the step stools and are constantly reminding children not to jump off the step stools. Based on interviews with S1, S2 and C2 there were only 2 children in the restroom with S1 when the incident occurred. Per S1 and C2, C1 jumped off of the step stool hitting C1's left upper cheek on the other step stool. Per S1 and S2, parent of C1, was picking up C1 at the time of the incident and took C1 to urgent care where glue was applied to C1 upper left cheek bone. C1 has returned to the facility. Per S1, there was no doctors note provided.

The facility is not being cited any deficiencies at this time.

An exit interview was conducted and a copy of this report was provided to Miranda Perez along with Notice of Site Visit that must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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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