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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340319282
Report Date: 10/16/2023
Date Signed: 10/16/2023 09:17:28 AM

Document Has Been Signed on 10/16/2023 09:17 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PASADENA STATE PRESCHOOLFACILITY NUMBER:
340319282
ADMINISTRATOR:BAGELMANN, LINDAFACILITY TYPE:
850
ADDRESS:4330 PASADENA AVENUETELEPHONE:
(916) 575-2374
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 16DATE:
10/16/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Linda BagelmannTIME COMPLETED:
09:30 AM
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Licensing Program Analysts (LPAs) Kyrsten Williams and Soleil Marx met with facility representative, Linda Bagelmann for an unannounced plan of correction inspection. Census included 16 children in care with 4 staff and a student volunteer. Facility is operating within the capacity and in compliance with staff child ratio on this day. Facility hours of operation are Monday through Friday 8:00 AM to 2:30 PM.

LPAs observed the facility's bathroom is clean, safe, sanitary and in good repair. LPA will clear deficiency CCR 101238(a) that was cited on 09/11/2023.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2023
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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