340319282-9-5-2025-03-CC-JMAA-DL8VGR-20250905162557

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340319282
Report Date: 09/05/2025
Date Signed: 09/05/2025 04:26:03 PM

Document Has Been Signed on 09/05/2025 04:26 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	PASADENA STATE PRESCHOOL		FACILITY NUMBER:	340319282
ADMINISTRATOR/ DIRECTOR:	BAGELMANN, LINDA		FACILITY TYPE:	850
ADDRESS:	4330 PASADENA AVENUE		TELEPHONE:	(916) 575-2374
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95821
CAPACITY: 25	TOTAL ENROLLED CHILDREN: 25	CENSUS: 13	DATE:	09/05/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:55 AM
MET WITH:	Linda Bagelmann		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Julia Maryanova met with Facility Director, Linda Bagelmann for an unannounced annual inspection of this preschool facility. Census included 13 children being supervised by 4 staff. Facility is operating within the capacity and in compliance with staff child ratio on this day. Licensee was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday 8:00 AM to 2:30 PM. LPA conducted a health and safety inspection of the facility, including all activity and classroom spaces, restrooms and outdoor play area. LPA observed the following documents are posted where visible to parents: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Classrooms all appeared clean, including the carpets and floor. The facility floor is in good repair and free of any hazards. The facility has age-appropriate furniture. The furniture is steady and in good repair. The play yard is free of hazards. All playground equipment and surfaces were inspected and are in good condition, with enough resilient material under climbing structures to absorb a fall. There are shaded areas for the children provided by the building and trees. All toilets, hand washing facilities are in working condition with proper sanitation in place. Bins for solid waste have tight fitting lids. The facility provides breakfast and lunch. Uncontaminated drinking water was readily available to children both indoors and outdoors. All the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. There are no poisons on the premises. LPA observed carbon monoxide detector, fire extinguisher, and first aid equipment. There is a working telephone at the site. There are no pools, spas or other bodies of water at the facility. There are no firearms or weapons on the premises. LPA reviewed the UC 311A, Records to Be Maintained at The Facility, for child's records, personnel records, and administrative records. LPA reviewed 3 children’s and 3 staffs' files. Each child's file had the required licensing documentation including emergency card, consent for emergency medical treatment, admission agreement, notification of children’s and parent’s rights, health history, physician’s report, and immunization records. LPA reviewed staff transcripts and observed all staff caring for children were qualified. Multiple staff have a current Pediatric CPR and First Aid certification. Staff all have current Mandated Reporter certificates and proof of immunization. LPA observed a current children's roster and a fire drill log which is one once a month. LPA observed that parents are signing their children in and out of the facility via electronic Child Plus app. *PAGE 1. REPORT CONTINUES ON LIC809-C*

NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Julia Maryanova
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PASADENA STATE PRESCHOOL	FACILITY NUMBER: 340319282
	VISIT DATE: 09/05/2025

NARRATIVE

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All staff currently employed with the facility have a criminal record clearance through the school district and documentation of the educational background, training, and/or experience. LPA reminded CDA that 100% supervision is required at all times, including in the bathroom. LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care 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).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

The director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 are available at: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the director Linda Bagelmann.

No deficiencies are cited today. A notice of site visit was given and must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Julia Maryanova
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/05/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025

LIC809 (FAS) - (06/04)

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