198017956-11-4-2022-33-CC-NTCG-CKUT9X-20221104143239

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017956
Report Date: 11/04/2022
Date Signed: 11/04/2022 02:32:43 PM

Document Has Been Signed on 11/04/2022 02:32 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:	CHILDREN'S CENTER AT CALTECH		FACILITY NUMBER:	198017956
ADMINISTRATOR:	SUSAN WOOD		FACILITY TYPE:	850
ADDRESS:	1200 E. CALIFORNIA BLVD		TELEPHONE:	(626) 395-6860
CITY:	PASADENA	STATE: CA	ZIP CODE:	91125
CAPACITY: 108	TOTAL ENROLLED CHILDREN: 108	CENSUS: 78	DATE:	11/04/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Susan Wood - Director		TIME COMPLETED:	03:10 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Nolan Tcheng and Veronica Martinez-Garza conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 09/15/2022. LPAs met with Director Susan Wood, who provided LPAs a tour of the facility inside and outside.

Census was taken. There were 78 children and 17 staff present.

On 09/15/2022, and incident was reported to the Department where a child was on the play structure outside, and jumped from the ladder section of the structure. Child landed on woodchips but sustained an injury to their leg. Teacher witnessed the injury and was able to respond to the injured child. Child has a fracture on their right leg, reveal by X-ray at the emergency room. Child needs assistance to walk. LPAs conducted a review of the Play structure during the tour and obtained pictures of the play structure where the child jumped from.

No deficiencies are being cited today, in accordance with California Code of Regulations, Title 22, Division 12.

The Notice of Site Visit (LIC9213) - must remain posted for 30 days, during the hours of operation after each site visit by a licensing representative.

Exit Interview conducted with Director Susan Wood at 3:10pm. Copy of Report was provided.

END OF REPORT

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

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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