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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015307
Report Date: 02/04/2025
Date Signed: 07/29/2025 09:05:26 AM

Document Has Been Signed on 07/29/2025 09:05 AM - 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:COLONIAL HOUSE PRESCHOOLFACILITY NUMBER:
198015307
ADMINISTRATOR/
DIRECTOR:		JOANNA HAWKINSFACILITY TYPE:
850
ADDRESS:1124 MISSION STREETTELEPHONE:
(626) 403-6554
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 47DATE:
02/04/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:31 PM
MET WITH:Miranda Perez, TeacherTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
NARRATIVE
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**This is an Amended report created by Licensing Program Analyst (LPA) Monique Ayala**

On February 4, 2025, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management inspection at the above facility. LPA met with teacher, Miranda Perez who guided LPA on a tour of the facility. LPA observed 47 children in care.

The purpose of the inspection is to ensure the health and safety for children in care. During the inspection, LPA observed that Staff #1 (S1) was not on the Guardian association list that was printed on 02/04/2025. LPA informed teacher Miranda. LPA checked on Guardian if S1 was cleared in the system. Per Guardian S1, was separated from the facility on 02/27/2024. LPA attempted to associate S1 to the facility but was unable to as S1 needs to be fingerprinted again.

Per teacher Miranda, S1 has been working at the facility for almost a year. LPA informed teacher Miranda that S1 needed to leave the facility and is not able to return until S1 has obtained fingerprint clearance from the department/Guardian. Per Office Manager, Sara the facility received a clearance letter for S1. LPA reviewed the letter and the letter is from Department of Justice (DOJ). LPA informed facility staff that the DOJ letter does not indicated the clearance for all three departments we require (DOJ, FBI and CACI).

NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2025
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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Document Has Been Signed on 07/29/2025 09:06 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/28/2025 04:54 PM


Created By: Monique Jessica Ayala On 02/04/2025 at 12:50 PM
Link to Parent Document Below:
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: COLONIAL HOUSE PRESCHOOL
FACILITY NUMBER: 198015307

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed




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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:Ana Chico
LICENSING EVALUATOR NAME:Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 07/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2025


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: COLONIAL HOUSE PRESCHOOL
FACILITY NUMBER: 198015307
VISIT DATE: 02/04/2025
NARRATIVE
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**This is an Amended report created by Licensing Program Analyst (LPA) Monique Ayala**

An exit interview was conducted and a copy of this report was provided along with Appeal Rights. Notice of Site Visit was provided and must be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC809 (FAS) - (06/04)
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