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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019029
Report Date: 08/22/2022
Date Signed: 08/22/2022 03:12:25 PM

Document Has Been Signed on 08/22/2022 03:12 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:ENCHANTED CASTLE PASADENA MONTESSORI SCHOOLFACILITY NUMBER:
198019029
ADMINISTRATOR:CHANG, JESSICAFACILITY TYPE:
850
ADDRESS:280 S. ROBLES AVETELEPHONE:
(626) 792-9280
CITY:PASADENASTATE: CAZIP CODE:
91101
CAPACITY: 45TOTAL ENROLLED CHILDREN: 42CENSUS: 35DATE:
08/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Denise Manaloto, StaffTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analysts (LPA) Thelma Razo conducted an unannounced Case Management – Incident inspection on this date, 8/22/2022. A COVID-19 risk assessment was made prior to entry to the facility. LPA met with facility representative Denise Manaloto. LPA stated the reason of the inspection is due to Unusual Incident which occurred on 8/8/2022 and was self-reported via phone by Ms. Manaloto to Community Care Licensing on 8/18/2022. The Unusual Incident was not reported within the required time frame.

During today's inspection, LPA toured the facility with Ms. Manaloto at 10:33AM. This includes playground and 2 classrooms. LPA observed 27 children and 3 teachers/1 aide in room #1, and 8 children with 1 teacher in room #2. Staff-child ratio was met. LPA interviewed 3 staff and 2 children.

A deficiency was cited per California Code of Regulations, Title 22 Division 12 Chapter 1 and is on LIC809-D..

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 08/22/2022 03:12 PM - It Cannot Be Edited


Created By: Thelma Razo On 08/22/2022 at 10:43 AM
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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ENCHANTED CASTLE PASADENA MONTESSORI SCHOOL
FACILITY NUMBER: 198019029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2022
Section Cited
CCR
101212(d)

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Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition,
a written report containing the information
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Facility representative is to submit a Declaration that the facility will be in compliance with Title 22 under Section 101212(d).
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specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This requirement was not met as evidenced by the incident that happened on 8/8/2022 but was reported via phone on 8/18/2022 which was beyond the required time frame as indicated under this section. Per Ms. Manaloto, the written report was mailed on 8/18/2022. This poses a potential health and safety risk to the 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Thelma Razo
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2022


LIC809 (FAS) - (06/04)
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