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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290371
Report Date: 09/20/2024
Date Signed: 09/20/2024 03:20:14 PM

Document Has Been Signed on 09/20/2024 03:20 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:JEFFERSON CHILDRENS CENTERFACILITY NUMBER:
191290371
ADMINISTRATOR/
DIRECTOR:		REE HUDSONFACILITY TYPE:
850
ADDRESS:391 NORTH SIERRA BONITATELEPHONE:
(626) 796-8845
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 31DATE:
09/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Carolina Arizaga - Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analysts (LPAs) Nolan Tcheng and Mariah Aguirre conducted an unannounced Case Management inspection to follow up on an incident report submitted to the Department on 09/18/2024. Upon arrival at 2pm, LPAs met with Site Supervisor Carolina Arizaga, to whom the purpose of the inspection was explained. Tour of the facility was provided. There were children present during the time of inspection.

Census was taken. There were 31 children with 9 staff members.

During today's inspection LPA obtained documentation in the form of:

  • Child Care Facility Roster
  • Staff Schedule
  • Sign in and Sign out for staff
  • Class attendance sheets
  • Facility Sketch
  • Email Threads

File review was also conducted on Child #1's documentation. There were no deficiencies observed during today's inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Site Supervisor Carolina Arizaga, at 3:25pm. Copy of Report provided.

END OF REPORT

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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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