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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290371
Report Date: 09/26/2024
Date Signed: 09/26/2024 12:48:12 PM

Document Has Been Signed on 09/26/2024 12:48 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: 47DATE:
09/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Carolina Arizaga - Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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Licensing Program Analysts (LPAs) Nolan Tcheng and Mariah Aguirre conducted a subsequent inspection of a Case Management inspection. Upon arrival at 11am, LPAs met with Site Supervisor Carolina Arziaga, 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 47 children with 9 staff members.

On 09/18/2024, an incident report was submitted to the Department regarding a possible Personal Rights violation that was reported to the facility. Facility provided information to the Department in their report. During today's visit, LPAs interviewed with five staff and two children. Documentation had been obtained previously, in the form of Child Care facility roster, Staff schedule, Sign in/out sheet, Class attendance sheet, facility sketch, and email threads.

LPAs reviewed information obtained during the interviews and information obtained from the documentation that was provided. Based on interviews and record review, no deficiencies are being cited in accordance with Title 22 regulations, at this time.

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

Exit interview conducted and report was reviewed with the SIte Supervisor Carolina Arizaga, at 12:55pm. Copy of report was provided.



END OF REPORT
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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