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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198017956
Report Date: 12/15/2022
Date Signed: 12/15/2022 03:48:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/21/2022 and conducted by Evaluator Roxana Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20220921135427
FACILITY NAME:CHILDREN'S CENTER AT CALTECHFACILITY NUMBER:
198017956
ADMINISTRATOR:SUSAN WOODFACILITY TYPE:
850
ADDRESS:1200 E. CALIFORNIA BLVDTELEPHONE:
(626) 395-6860
CITY:PASADENASTATE: CAZIP CODE:
91125
CAPACITY:108CENSUS: 83DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Susan Wood, DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Child sustained a fractured leg while in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Roxana Lopez and Lilli Babcock conducted a Complaint Investigation on this date. A risk assessment was conducted upon entry and appropriate PPE was used. The purpose of this visit is to provide findings of the complaint investigation which was received on 9/21/2022. LPA met with Director Susan Wood and Assistant Director Olivia Garcia, to whom the purpose of the inspection was announced. A tour of the facility was given, and the census was taken.

Throughout the course of the investigation, interviews were conducted with reporting party, staff, children, and parents. LPA also reviewed and obtained copies of children’s rosters, personnel reports, pictures, written declarations, and other supporting documents.

Regarding allegation #1: C1 sustained a fractured leg while in care. LPA conducted interviews with reporting party, staff, children, and parents. A total of eight interviews were conducted with staff. Staff 1 – 8 (eight staff) corroborated that if children feel comfortable jumping off the structure they are not stopped. --pg.1 of 3
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 33-CC-20220921135427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CHILDREN'S CENTER AT CALTECH
FACILITY NUMBER: 198017956
VISIT DATE: 12/15/2022
NARRATIVE
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LPA Lopez measured the distance from the platform to the woodchips - which is the distance C1 jumped. The distance measured 3 feet 8 inches

Staff 3 - 8 (five staff) corroborated that even though they do not stop children from jumping, if they observe a child is hesitant to jump or not jumping properly, they will talk to the child and access the situation.

Staff 6 - 8 (three staff) corroborated that C1 is a newer child to the facility and on the younger side. Both staff further stated that taking those two factors into consideration, they would talk to the child and encourage them to jump from a lower step.

Staff 3 – 8 (five staff) corroborated that when a child is on the structure the structure is always directly supervised - stating that the area where they stand is in front of the structure where the opening is, as that is the area that children use for jumping.

Staff 1 - 8 (eight staff) corroborated that C1 did jump off the structure injuring their leg.

Per Staff 4, they were sitting at the snack table with two children who were finishing snack, when Staff 4 states that they observed C1 jump successfully off the structure before getting injured. Staff 4 states that they were positioned behind the area of the structure from where C1 jumped. C1 had their back facing Staff 4 when they jumped. Staff 4 could not see Child 1’s facial expression when they jumped off the structure.

C1 jumped off the platform of the structure and began to cry and Staff 4 went to help C1. Per Staff 4 they were not directly supervising the structure as they were sitting down at a table behind the structure supervising snack. Staff 4 observed C1 falling through the bars on the structure.

Per Staff 3 they were by the tire swing when they heard C1 cry. LPA observed the tire swing to be approximately 30 feet from where C1 jumped. Staff 3 turned to look at C1 and observed Staff 4 helping C1. ------------------------------------------------------ pg.2 of 3 -----------------------------------------------

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 33-CC-20220921135427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CHILDREN'S CENTER AT CALTECH
FACILITY NUMBER: 198017956
VISIT DATE: 12/15/2022
NARRATIVE
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Staff 2, 3, and 4 corroborated that Staff 4 called the front for help.

Staff 3 provided ice once Staff 2 arrived. Staff 2 remained with the child, and campus security and C1’s parents were called. C1 was assessed by campus security who advised the parent to take C1 to the emergency department since C1 was not able to move their leg and might need an X-ray.

LPA conducted interviews with 5 children. Children 1-5 corroborated that they are allowed to jump off the structure and that there’s always a teacher supervising the structure area. Additionally, LPA conducted interviews with parents. Parent # 1 and 2 corroborated they had no concerns. Parent # 3 expressed concern regarding the structure and children being allowed to jump off as it seemed to high.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number)A technical violation was given please attached LIC 9102 Technical Violation form.



On the day of the incident, the structure was not directly supervised. Staff 3 – Staff 8 corroborated that the structure is an area that is always directly supervised to observe the children’s jumping ability and assess any hesitation by a child. LPAs observed an empty chair in this area during visits conducted on 09/26/2022, 11/10/22 and 12/15/2022. Staff 6 and Staff 8 corroborated that C1 was newer to the facility and on the younger side. The facility failed to provide proper supervision to be able to observe any hesitation or assess the situation of a younger child jumping to prevent injury.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Susan Wood and Assistant Director Olivia Garcia. -------------------------------------pg. 3 of 3 ------------------------------------------------------------

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3