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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019873
Report Date: 05/13/2021
Date Signed: 05/13/2021 05:00:52 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:ENCHANTED CASTLE SAN MARINO MONTESSORI SCHOOLFACILITY NUMBER:
198019873
ADMINISTRATOR:JESSICA CHANGFACILITY TYPE:
850
ADDRESS:444 & 464 S. SIERRA MADRETELEPHONE:
(626) 577-8007
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY:104CENSUS: 49DATE:
05/13/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Parima MadanTIME COMPLETED:
02:00 PM
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A Case Management site visit was conducted today by Judy Mora, LPA to inspect and measure the preschool facility for capacity determination in one classroom. Licensee is currently Licensed for a preschool program with a capacity of 104.
The fire clearance was approved on 03/31/21.

A temporary partition was placed in the classroom to separate preschool children from school age children. Per Licensee the partition is only temporary until the school age children end the school year. The following measurements were taken and totaled:
-Indoor Space: Room 5 allows for 11 children.

Capacity Increase will be granted pending file review.

An exit phone interview has been conducted with Parima Madan. A copy of this report has been signed by LPA Mora. This report will be e-mailed to Parima Madan, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. A hard copy of this report, will be mailed to Applicant and agrees to sign the bottom of each page of the LIC 809 and return the originals to LPA Mora in-person or via U.S. Mail.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
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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