Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290371
Report Date: 10/21/2016
Date Signed: 10/21/2016 11:06:51 AM

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:JEFFERSON CHILDRENS CENTERFACILITY NUMBER:
191290371
ADMINISTRATOR:CLAUDIA RAMONFACILITY TYPE:
850
ADDRESS:391 NORTH SIERRA BONITATELEPHONE:
(626) 796-8845
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:70CENSUS: 27DATE:
10/21/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Laura Ochoa & Carolina ArizagaTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Ana Chico conducted an unannounced Random Visit. LPA met with Laura Ochoa, Teacher. Three assistant were present along with Director, Carolina Arizaga, who arrived during the visit. Jefferson Children's Center is located on the south end of the Jefferson Elementary School campus. It is physically separate from the elementary school via gates. Parents and visitors enter on Sierra Bonita Ave. There are currently two rooms being used for care. Center hours are 7 AM - 6 PM.

Each classroom has central air and heat. Furniture and equipment observed to be age appropriate. Land line telephone service is available throughout the entire center so that teachers from each classroom can communicate with each other and with the main office. Each room has storage cubbies for children's belongings. Ill children are sent to the office until picked up by parent/guardian. There is a cot available for ill children. There are two restrooms between both classrooms. Restrooms are clean, odor free, and supplied adequately with disposable paper towel, dispensable soap, and toilet paper. First Aid supplies were available in each classroom as well as the Director's Office. Cots are stored away when not in use. Linens for the cots are washed on site.

Meals and snacks are prepared and delivered from the elementary school cafeteria. Facility has a kitchen for refrigerating perishable food items and for keeping food warm. Kitchen is clean and orderly. Flooring is clean. There are no signs of vermin (droppings or urine).

There is one large outdoor play yard which is completely fenced. There is shade via trees. Swings use sand as cushioning material. There playground also has a grassy area for children to play and hard hard surfaces to ride bikes.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-395
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2016
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JEFFERSON CHILDRENS CENTER
FACILITY NUMBER: 191290371
VISIT DATE: 10/21/2016
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LPA did not observed bodies of water. At the time of the visit all ratios were met. LPA reminded Director of minimum staff requirements (1 teacher to 24 children).
Care and supervision was observed by LPA and deemed appropriate. Sign in and out sheets and procedures were reviewed with staff policy of checking children for illness. Personal Rights of children were observed by LPA. Children's records were reviewed. Staff are fingerprint cleared as a condition of employment by the school district. All staff are certified in pediatric CPR/First Aid and health preventative practices through the American Red Cross. Inspection of required forms made. IMS plan has been submitted and will be reviewed.


There were no deficiencies cited in accordance with Title 22 California Code of Regulations. Appeal rights explained.Exit interview conducted with director.

The LIC 9213, Notification of a Site Visit was posted on parents board on entry to the facility. This notice is to be posted for 30 consecutive days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-395
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2016
LIC809 (FAS) - (06/04)
Page: 2 of 2