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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021090
Report Date: 11/29/2022
Date Signed: 11/30/2022 08:33:44 AM

Document Has Been Signed on 11/30/2022 08:33 AM - 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:FIREHOUSE SCHOOL, PASADENAFACILITY NUMBER:
198021090
ADMINISTRATOR:MARCELLINE, CATHERINEFACILITY TYPE:
830
ADDRESS:1041 ALTADENA DRTELEPHONE:
(626) 524-6477
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
11/29/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Catherine & Charles MancellineTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Cynthia Reyes, conducted an announced pre-licensing site Inspection to inspect and measure the requested Infant component for capacity determination. LPA met with Catherine & Charles Mancelline, owners, Gayane Andreasyan, Director, and Champa Perera, consultant. The applicant is requesting a total capacity of 24 Infant children, The days & hours of the day care will be Monday-Friday 7AM-6PM.

At 9AM, LPA began the tour of the facility with Catherine & Charles Mancelline, owners, and Gayane Andreasyan, Director, who states the infant parents will enter and exit down the steps of the front of the school off the street Casa Grande. The facility is located on the Pasadena Church of the Bretheren.
Parents will sign the child in/out in the front lobby area. Parents will walk their child to their class room, which at that time all precautionary measures including health checks will be taken. LPA observed a parent board at the front lobby entrance with all the required posting visible for all to see.

The ill/isolation area will be located in the staff lounge that also has the staff bathroom and has a mat/cot/chair for a child to rest if needed. A fully equipped first aid kit is available on site in each class room with all the required first aid supplies.

LPA did not observe any accessible disinfectants, cleaning solutions, poisons and any other items that could pose a danger to children. Medication is stored in a box on a high shelve in the class room.

LPA advised the applicant how to access forms, regulations providers information notices (PINs), regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FIREHOUSE SCHOOL, PASADENA
FACILITY NUMBER: 198021090
VISIT DATE: 11/29/2022
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10 AM, Licensing staff was then guided through the proposed Infant classroom. LPA observed play equipment, furniture and materials and were inspected to be in good repair as well as for cleanliness, safety and age appropriate. Individual storage space was observed to be available for each child. Napping equipment, cribs (8)/cot (10) were observed to be in good condition, with appropriate storage and cleanliness. Water jug is available and child will bring own water bottles labeled with child's name and will be available in the class room so the child may drink freely.

Telephone service, heating, lighting and ventilation were evaluated. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, paper towels, toilet paper, safety and sanitation. The Infants bathroom is located inside the class room. LPA observed the bath room to have 2 toilet (Cap 30) and 3 sinks (Cap 45). Changing Table is placed with in arms reach of the sink.

The tour continued as the LPA were guided to the outdoor play area. The infants will access their outdoor play yard by walking right outside their class rooms back door that leads directly in to their play yard. Water jugs with labeled bottles will be used for children while outdoors. LPA observed age appropriate outdoor toys and play equipment to be clean safe and in good repair, as well as adequate shade is available. All areas around play equipment and slides are cushioned with material to absorb a fall. LPA advised Catherine & Charles, owners, and Gayane, Director, that the children need to be within the direct care and supervision, including visual observation and supervision of the teacher(s) at all times.

All snacks, breakfast, and lunch will be provided by the parents. Food will be prepared/warmed in the kitchen that has a refrigerator and microwave. A monthly food menu will be available and posted of items available if a child does not bring their daily food items. Trash cans used to discard food have tight fitting lids. Continue on page 3
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FIREHOUSE SCHOOL, PASADENA
FACILITY NUMBER: 198021090
VISIT DATE: 11/29/2022
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Carbon monoxide detectors and smoke detectors are present and are in operable condition in the facility. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Fire extinguishers were serviced on 09/30/2022 as reviewed by the tag on the fire extinguishers located through out the facility. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Hazardous items including poisonous cleaning compounds were observed to be stored inaccessible to children.

Items discussed during this Inspection:
Licensing does not tolerate the following: Refused Entry to a Facility or Any Part of a Facility is a
violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both.
Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.
Current Children’s Roster LIC 9040: Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This children roster must be updated and available to the licensing agency upon request.
Pediatric First Aid and CPR: At least one person in the facility, along with the Director/Administrator must be trained in Pediatric First Aid and CPR and present in the facility.
Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.
Qualifications and staff files: Educational background, training, and/or experience and all required documents by the department for each staff present must be available for review.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FIREHOUSE SCHOOL, PASADENA
FACILITY NUMBER: 198021090
VISIT DATE: 11/29/2022
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11AM Continued: Items discussed during this Inspection:

Children’s Records: All required licensing documents must be available for review; including but not limited to, the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary. Director advised to visit www.shotsforschool.org for immunization information.
Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or
volunteer at a day care center if he or she has not been immunized against influenza, pertussis, & measles.
Criminal background clearance: LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check.
Reporting Requirements Section 101212: Changes at the facility must be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location. The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation.

Incidental Medical Services (IMS): This facility will conduct Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FIREHOUSE SCHOOL, PASADENA
FACILITY NUMBER: 198021090
VISIT DATE: 11/29/2022
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Safe Sleep: LPA discussed the safe sleep regulations with applicant and Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant and Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

Based on the LPA observation, the following corrections need to be corrected before a license can be granted.



1) Waiver for staggered outdoor play (9 only at a time)
2) Final File Review
3) Proof of MMR for the owner and the Director


The facility has 2 toilet (Cap 30) and 3 sinks (Cap 45). Fire clearance is on file and approved for the lower capacity of 20. Outdoor measurements were determined to have outdoor capacity of only 9.

Based on LPA measurements taken and observations of the facility, the indoor measurements will be approved for a capacity of 18 Infants once all corrections are completed and verified.

12PM Exit interview conducted with Catherine & Charles Mancelline, owners and a signed copy of this report and the notice of site visit was provided on this date.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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