Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290371
Report Date: 08/28/2019
Date Signed: 08/28/2019 08:47:13 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:REE HUDSONFACILITY TYPE:
850
ADDRESS:391 NORTH SIERRA BONITATELEPHONE:
(626) 796-8845
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:70CENSUS: 32DATE:
08/28/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Teacher Kerem MartinezTIME COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) Ariel Cazares conducted an unannounced case management inspection on this date. LPA met with Teacher Kerem Martinez, as Site Supervisor was not available at the time of inspection. Upon arrival LPA observed a total of 32 children and 5 staff amongst 2 classrooms.

The purpose for this inspection was to follow up on a deficiency cited on 7/23/19 during an inspection. LPA observed there to be school-age children present during that inspection without a license or waiver on file. The school-age children belonged to an exempt program with Jefferson Elementary School.

On this date LPA inspected the facility and did not observe the school-age children present. LPA informed Teacher Karen that the school-age children are not allowed in the facility without prior approval from the Department. LPA found the violation was corrected on this date.

Per a conversation with Program Specialist Patricia Guzman, the children were removed from the facility and will no longer be using the classroom.

Exit interview conducted with Teacher Kerem Martinez. A copy of this report and appeal rights were provided and explained.

The Notice of Site Visit (LIC 9213)must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
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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