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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004054
Report Date: 06/02/2022
Date Signed: 06/02/2022 12:54:00 PM

Document Has Been Signed on 06/02/2022 12:54 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:WASHINGTON ACCELERATED SCHOOL ECPFACILITY NUMBER:
198004054
ADMINISTRATOR:PATRICIA GUZMANFACILITY TYPE:
850
ADDRESS:1520 N. RAYMOND AVE.TELEPHONE:
(626) 791-4573
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 49DATE:
06/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Dina Perez, Site SupervisorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Fabiola Vasquez conducted a Case Management for the purpose of Amending a report documented on 4/11/22. LPA amended the report due to a typo on Page 2, corrected report was provided. Exit interview was conducted with Dina Perez, Site Supervisor. A copy of this report along with the appeal rights were provided.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2022
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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