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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003398
Report Date: 10/08/2024
Date Signed: 10/22/2025 02:38:32 PM

Document Has Been Signed on 10/22/2025 02:38 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:CHILD EDUCATIONAL CENTER, CALTECH/JPL COMMUNITYFACILITY NUMBER:
198003398
ADMINISTRATOR/
DIRECTOR:		CHRISTY WATERMANFACILITY TYPE:
840
ADDRESS:471 KNIGHT WAYTELEPHONE:
(818) 790-2347
CITY:LA CANADASTATE: CAZIP CODE:
91011
CAPACITY: 125TOTAL ENROLLED CHILDREN: 125CENSUS: 23DATE:
10/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Chelsea Piatetsky TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Amended Report

On 10/08/24, at 12:30 pm, Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced Case Management inspection for the purpose of following up on an unusual incident report received by the Department. Upon arrival, LPA met with Site Coordinator Director, Chelsea Piatetsky, to whom the reason was explained. A tour of the facility was provided. There were children present during the inspection.

The census was taken. There were 23 children and 2 staff members.

On 09/12/24, an unusual incident report was submitted to the Department regarding a child sustaining an injury on the facility grounds. C1 was playing on the monkey bars at the playground structure when C1 missed the bar and fell. C1 was seen by a doctor who confirmed that C1 had a broken elbow needing a full arm cast.

During the investigation, LPA observed the area where the incident took place. Obtained pictures of monkey bars, band-aid report, interviewed staff members, and children. Ten children were present with 1 staff member at the time of the incident. S1 stated that they were positioned on the other side when the incident took place. Per S1, they observed C1 when C1 was already sitting on the floor. C2, C3 stated being next to C1 during the incident and observed C1 on the monkey bar when C1 fell. C1 stated they were on the last monkey bar when their hands slipped, and they fell, landing on their hand. During the interviews with children, information was disclosed that S1 was sitting when the incident occurred and was observed on the phone.

This is the 2nd incident that has occurred since 06/29/2017 regarding a child getting injured while using the monkey bars. As a reminder, the facility was provided with a Technical Advisory.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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 is an Amendment of Original Document on 04/24/2025 04:25 PM


Created By: Shushanik Safaryan On 10/08/2024 at 02:33 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILD EDUCATIONAL CENTER, CALTECH/JPL COMMUNITY
FACILITY NUMBER: 198003398

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
10/09/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervisio (a) The licensee shall provide care and supervision ...(1) No child(ren) shall be left without the supervision of a teacher at any time... . Supervision shall include visual observation. This requirement did not met evidenced by :


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Site Coordinator stated she will talked to the staff regarding active supervision , safey when using Monkey Bars . Facility will conduct the training and will create plan how to provide active supervision , will discuss phone policy . Meeting agenda along with staff members signatures will be emailed to LPA by POC date .
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C1 was hurt on the facility grounds . Based on the information obtained S1 was sitting during the incident and did not observe the incident .
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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:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024


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: CHILD EDUCATIONAL CENTER, CALTECH/JPL COMMUNITY
FACILITY NUMBER: 198003398
VISIT DATE: 10/08/2024
NARRATIVE
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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.

An exit Interview was conducted, a copy of this report, along with Notice of Site visit and Appeal Rights, were explained and provided to the Facility Representative, Chelsea Piatetsky, on 10/08/24.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC809 (FAS) - (06/04)
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