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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010409
Report Date: 11/01/2022
Date Signed: 11/01/2022 04:34:01 PM

Document Has Been Signed on 11/01/2022 04:34 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SIERRA MADRE EARLY CHILDHOOD PROGRAMFACILITY NUMBER:
198010409
ADMINISTRATOR:PATRICIA GUZMANFACILITY TYPE:
850
ADDRESS:141 W. HIGHLAND AVETELEPHONE:
(626) 355-1428
CITY:SIERRA MADRESTATE: CAZIP CODE:
91024
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 9DATE:
11/01/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
04:07 PM
MET WITH:Executive Assistant, Richard IbarraTIME COMPLETED:
04:30 PM
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An unannounced Case Management Annual Continuation visit was conducted by Licensing Program Analyst (LPA), Bardo Baluyot for the purpose of reviewing staff files. Files were not available during the initial visit conducted on 10/19/22 as Staff files were stored in Pasadena Unified School District's Human Resources office located at 351 S. Hudson Ave. Pasadena 91101 (Rm116). LPA met with Executive Assistant to Director of Human Resources, Richard Ibarra.

Staff records were reviewed and found to be complete.
There were no deficiencies observed on this date in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes.

Exit interview was conducted with Mr. Ibarra. Appeal rights and procedures explained.

A copy of this report was provided.

Visit: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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