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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021680
Report Date: 03/06/2025
Date Signed: 03/06/2025 02:27:44 PM

Document Has Been Signed on 03/06/2025 02:27 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:JEFFERSON PRESCHOOLFACILITY NUMBER:
198021680
ADMINISTRATOR/
DIRECTOR:		LINDSAY LEWISFACILITY TYPE:
860
ADDRESS:1500 E VILLA STTELEPHONE:
(626) 396-5762
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY: 40TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/06/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Patricia GuzmanTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 03/06/2025 at 12:15 pm, Licensing Program Analysts (LPAs), Elka Chavez and Joshua Ortega conducted an announced Pre-Licensing inspection for an Emergency Relocation due to the recent Los Angeles Fire Disaster. The Licensee, Pasadena Unified School District Child Development was previously licensed to operate at 524 Palisade St., Pasadena, CA 91103 under license 191231002 with a capacity of 120 preschool children from ages 3 to 5 years old.

Upon arrival, LPAs met with Applicant Representative, Patricia Guzman. Applicant, Pasadena Unified School District Child Development, has requested to relocate their existing licensed Preschool Program (191231002) as a result of the LA Fires to a new permanent location. The Applicant is requesting to serve 29 children: (29) Preschoolers from 3 to 5 years old in classrooms: 26 and 28. Hours of operation will be Monday through Friday, the preschool will have two (2) half day sessions, 7:45am to 10:45am and 11:15am to 2:15pm.

This facility was observed to be located on the property of Jefferson Elementary. LPAs informed applicant representative that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, applicant representative stated that they will be stored in a secured location within the kitchen area in each classroom. A fully equipped first aid kit is located in each classroom. There is an operational carbon monoxide detector in classroom 26. All required licensing documents were observed posted near the entrance of classroom 27. LPAs observed classrooms 26 and 28 are accessed through classroom 27. Children will be signed in and out at the entrance of their designated classroom using a QR code for Care Connect Mobile.

LPAs continued to tour the facility and measured all indoor and outdoor activity space. The total preschool indoor activity space measured was 1017.73 square feet, which is sufficient to accommodate the overall requested capacity of 29 preschool children.

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SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JEFFERSON PRESCHOOL
FACILITY NUMBER: 198021680
VISIT DATE: 03/06/2025
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LPAs observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, bookshelves, and other activity supplies for the children. Drinking water will be available to children via water bottles into each child’s personal water bottle. LPAs observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Fire clearance was granted on 2/28/2025.

LPAs observed a total of 2 sinks and 4 toilets available for children’s use. These are sufficient to accommodate the requested capacity of 29 children. There is a separate staff restroom equipped with a toilet and a sink that is accessible to staff next to the library area of the elementary school. The isolation area for children who are ill will be located in classroom 27.

The facility will provide breakfast and lunch. Children will eat their meals inside their classrooms. The meals are prepared and delivered on site from Pasadena High School. There is a kitchen area in each classroom equipped with a sink, food prep area and microwave.

The facility currently has a fully fenced playground area. The fencing surrounding the playground area is made of chain link fencing which was observed to be at least four feet high. LPAs obtained measurements of the designated outdoor area which calculated to be 7345.42 square feet, which is sufficient to accommodate the requested capacity of 29 preschool children. LPAs observed shade is provided via shade structure. There are sufficient outdoor age-appropriate toys and play equipment available within the playground area. There is a climbing structure on the playground for children which is properly anchored. There is adequate cushioning in fall zones of climber provider by padded turf. Drinking water will be available via water bottles with each child’s personal water bottles. LPAs observed all hazardous items on the playground to be inaccessible to children. Applicant Representatives was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JEFFERSON PRESCHOOL
FACILITY NUMBER: 198021680
VISIT DATE: 03/06/2025
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Applicant representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Applicant Representative was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communications.

No corrections are needed. A license for (29) children: (29) Preschoolers from ages 3 to 5 years old will be granted upon a final file review.

Exit interview conducted and report was reviewed with the Applicant Representative, Patricia Guzman.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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