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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021707
Report Date: 03/24/2025
Date Signed: 03/24/2025 01:07:24 PM

Document Has Been Signed on 03/24/2025 01:07 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:ALTADENA BOYS & GIRLS ACADEMYFACILITY NUMBER:
198021707
ADMINISTRATOR/
DIRECTOR:		GAYANI M NEANGODAFACILITY TYPE:
860
ADDRESS:414 N LAKE AVETELEPHONE:
(626) 345-0540
CITY:PASADENASTATE: CAZIP CODE:
91101
CAPACITY: 35TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/24/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Gayani NeangodaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 3/24/2025 at 10:00 am, Licensing Program Analyst (LPA), Crystal Green conducted an announced Pre-Licensing inspection for an Emergency Relocation due to the recent LA Fire Disaster. The previous facility location was licensed to operate at 2151 N. Lake Avenue, Altadena, CA 91001 as a Preschool Program 198012856 with a capacity of 22 children from ages 2 until entry into first grade and a School- Age Program 198012857 with a capacity of 13 children from ages first grade and above.

Upon arrival, LPA met with Applicant Representative, Gayani Neangoda. The applicant, Altadena Boys & Girls Inc., has requested to be licensed to serve 35 children: (22) Preschool children from ages 2 to 5 years old and (13) School- Age children from ages TK to 13 years old. Hours of operation will be Monday to Friday from 6:00 am to 6:00pm.

This facility will be accessible from the rear of the building via the back-alley way entrance from E. Maple St. The childcare center will operate out of 2 floors. The preschool classrooms will be located on the first floor, along with one school- age TK classroom located near the front entrance of the building. Additional School- Age classrooms will be located on the 2nd floor of the building.

All indoor and outdoor activity space utilized for the children was inspected today. LPA informed applicant representative that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, applicant representative stated that they will keep it in a locked medicine box located in the Director’s office area. A fully equipped first aid kit is also kept in the Director’s office area. There is an operational carbon monoxide detector on site located near the kitchen area. All required licensing documents are to be posted near the main entrance of the facility. Children will be signed in and out at the main entrance of the facility.
NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Crystal Green
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: ALTADENA BOYS & GIRLS ACADEMY
FACILITY NUMBER: 198021707
VISIT DATE: 03/24/2025
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LPA continued to tour the facility and measured all indoor and outdoor activity space. The total indoor activity space for the preschool measured 619. 49 square feet which can only accommodate 17 preschool children. The total indoor activity space for school-age measured 446.69 square feet which can only accommodate 12 school- age children.

LPA observed all indoor activity space to be complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, napping cots, bookshelves, and other activity supplies for the children. The toys are safe with no sharp edges, splinters, or points, nor made of small parts that can present a choking hazard. Drinking water will be available to children via water igloo jug. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property.

LPA observed a total of (2) sinks and (2) toilets available for preschool children’s use located on the first floor. These are sufficient to accommodate the requested capacity of preschool children. There are (1) sink and (1) toilet located on the second floor available for the school-age children. The school-age restroom afford privacy for children. There is a separate staff restroom equipped with a toilet and a sink. The isolation area for children who are ill will be the staff restroom that is located on the first floor.

Facility will provide AM and PM snacks and Lunch. The kitchen area currently includes several sinks, stove, and food prep counter. Per Ms. Gayani, the refrigerator will be delivered later this week. The kitchen area and food storage areas were observed free of rodents and/or vermin. Hazardous items in the kitchen are inaccessible to children via locked door.

The facility currently has a fully fenced playground area. Fencing is made up of brick wall and wrought iron which is at least four feet high. The total square footage for all the outdoor activity space is 2,810 square feet, which is sufficient to accommodate the requested capacity. LPA observed the playground area to be incomplete. Per Ms. Gayani, she plans to submit a waiver requesting to allow both programs to share the outdoor space at different times in the AM and PM in order to allow both groups of children to be able to participate in the different activity structures and outdoor picnic tables.
Applicant representative was reminded that any changes to the facility must be reported to and approved by Community Care Licensing. Transportation will be offered to the school-age children.
NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Crystal Green
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ALTADENA BOYS & GIRLS ACADEMY
FACILITY NUMBER: 198021707
VISIT DATE: 03/24/2025
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For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

Applicant representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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) or (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

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communications.
NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Crystal Green
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: ALTADENA BOYS & GIRLS ACADEMY
FACILITY NUMBER: 198021707
VISIT DATE: 03/24/2025
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The following corrections are needed prior to the issuance of the license:
    • The Applicant must obtain and submit proof of a (2) barrier gate for the school-age classroom located on the first floor.
    • The Applicant must obtain and submit proof of the shade, age-appropriate toys and play equipment for the outdoor area.
    • The Applicant must obtain and submit proof of adequate cushioning in fall zones of the outdoor area.
    • The Applicant must obtain and submit proof of refrigerator for the Kitchen area.
    • The Applicant must submit a waiver request letter requesting to allow the outdoor space to be shared between programs.
    • The Applicant must receive Fire Clearance approval from the Pasadena Fire Department.

LPA discussed with the applicant representative the additional pending documents that may be requested to complete the application process. Applicant understands that the facility may be issued a provisional license to assist with the Emergency Relocation request until the application process is complete. Once an approved fire clearance is received from the Pasadena Fire Department, a provisional license will be issued for (29) children: (17) preschool children from ages 2 to 5 years old and (12) school age children from ages TK to 13 years will be granted.

Exit interview conducted and report was reviewed with the Applicant Representative, Gayani Neangoda.
NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Crystal Green
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4