Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290371
Report Date: 07/23/2019
Date Signed: 07/23/2019 12:06:35 PM

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:REE HUDSONFACILITY TYPE:
850
ADDRESS:391 NORTH SIERRA BONITATELEPHONE:
(626) 796-8845
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:70CENSUS: 72DATE:
07/23/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Carolina ArizagaTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ariel Cazares conducted an unannounced case management inspection on this date to address an unusual incident that was reported to the department. LPA toured the facility and observed a total of 72 children amongst the 4 classrooms on site.

On 7/12/19, the Department received a unusual incident report regarding a child's personal rights violation. LPA conducted interviews with staff and a child. LPA reviewed documentation pertinent to the incident. At this time additional information is needed prior to determining if a violation occurred.

At the time of inspection LPA observed 72 children (including 13 schoolage children in classroom 5). The facility does not have a school-age license at this location. There is no waiver on file for use of Room 5 by school-age children. LPA spoke with Patricia Guzman who is the director for the facility who stated the school-age program is license exempt and was unaware that they could not use Room 5. The preschool license is exclusively to serve children from 3 until entry into kindergarten. Due to school-age children being present in the preschool facility without an approved waiver, the facility will be cited for operating beyond the limitations of their license.

See 809-D for deficiency cited. An exit interview was conducted with Site Supervisor Carolina Arizaga.
Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. A copy of the LIC9224 was provided.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/23/2019
Section Cited
CCR
101161(a)
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Limitations on Capacity and Ambulatory Status
A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement has not been met as
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Per Director Patricia Guzman, she will look into the matter in order to take action needed to correct issue.
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evidenced by LPA's observations of 13 school-age children in Room 5. The facility's license is granted to care for children 3 until the entry into kindergarten. There is no waiver on file for use of Room 5 to be used by school-age children. This poses an immediate risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019
LIC809 (FAS) - (06/04)
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