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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020150
Report Date: 10/29/2024
Date Signed: 10/29/2024 03:40:27 PM

Document Has Been Signed on 10/29/2024 03:40 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:MENTOR PRESCHOOL ON LAKEFACILITY NUMBER:
198020150
ADMINISTRATOR/
DIRECTOR:		JASMIN MANZANEROFACILITY TYPE:
850
ADDRESS:232 N. LAKE AVE #100TELEPHONE:
(626) 437-5506
CITY:PASADENASTATE: CAZIP CODE:
91101
CAPACITY: 75TOTAL ENROLLED CHILDREN: 66CENSUS: 34DATE:
10/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Jasmin Manzanero, DirectorTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Saul Valenzuela conducted an unannounced Case Management inspection due to an incident that was reported to the Department on 10/17/2024. LPA met with Owner German Salcedo and Director Jasmin Manzanero who guided LPA on a tour of the facility. Census was taken.

On October 17th, 2024, an incident was self reported to the Department via Telephone by the facility who reported a parent alleged that a child's personal rights were violated while in care that required medical treatment.



All reports were reported within the required 24 hours. The purpose of the inspection was to obtain additional information regarding the incident reported to the Department.

During the inspection, LPA Valenzuela conducted interviews with five staff and one child. There were no disclosures made on this date regarding personal rights violations. LPA asked for copies of declarations, Employee Handbook, Parent Handbook, Children Roster (LIC 9040), and Personnel Roster (LIC 500).

At this time, the licensee is in compliance with California Code of Regulations Title 22. Incident requires further investigation- No deficiencies cited on this date.

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

Exit interview conducted and report was reviewed with facility representative, German Salcedo.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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