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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017956
Report Date: 01/20/2023
Date Signed: 01/20/2023 01:25:18 PM

Document Has Been Signed on 01/20/2023 01:25 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 CALTECHFACILITY NUMBER:
198017956
ADMINISTRATOR:SUSAN WOODFACILITY TYPE:
850
ADDRESS:1200 E. CALIFORNIA BLVDTELEPHONE:
(626) 395-6860
CITY:PASADENASTATE: CAZIP CODE:
91125
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: 59DATE:
01/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Susan Wood - DirectorTIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection to follow up on an incident report submitted to the department on 01/12/2023. Upon arrival at 10:17am, LPA was greeted by Director Susan Wood, to whom the purpose of the inspection was explained. At 10:25am, LPA was provided a tour of the facility where there were children present during the time of inspection.

Census was taken. There were 59 children and 17 staff members.

On 01/11/2023, a parent arrived to pick up their child from the facility. During interaction with their child, the child wished to stay longer to play. Parent allowed child to stay and play outside a little longer while they gathered their child's belongings and took them to a car. The child then left the outdoor play area to search for their parent and walked through the lobby and outside to the parking lot before anyone noticed that they were not being supervised by staff or parent. Per Interview with Staff #2 and Parent, the child was allowed to stay and play longer and staff were notified of this allowance, but child was not signed out when they had walked through the lobby. Interviews with Staff corroborate that no one visually observed the child leave the lobby and to the outside parking lot in front of the building. Parent states they had taken the child's backpack to the car and drove to the grocery store briefly to let child play longer. They were called very soon after regarding their child at the facility and the incident. During the inspection, LPA obtained sign in/sign out template form, copy of parent handbook, and written staff statements regarding the incident. Written statements confirm staff being notified of child staying longer and then not being able to locate child prior to staff #4 finding child outside in parking lot. Interviews were conducted with 4 Staff members and Parent. Based on interview and record review, the facility was in violation of California Title 22 Code of regulations for "Personal Rights" and "Responsibility for Providing Care and Supervision."

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.


REPORT CONTINUES PAGE 1 of 2
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/20/2023
NARRATIVE
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Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

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.



Exit interview was conducted with Director Susan Wood, and Plan of Corrections were reviewed and developed.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/20/2023 01:25 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 01/20/2023 at 12:41 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDREN'S CENTER AT CALTECH
FACILITY NUMBER: 198017956

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/23/2023
Section Cited
CCR
101223(a)(2)

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101223 (a)(2) Personal Rights
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.



This requirement was not met as evidenced by:
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Per Director, the gate to the lobby door will be modified so that it will be raised. The lobby door will be shut from now on to present ease of traffic from all persons. Director will have all staff watch Children's Personal Rights in Child Care on Www.childcarevideos.org/child-care-center/operators/.
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Based on interview and record review, child was able to freely move from play area, to the facility lobby, and to the outdoor parking lot without any resistance from staff or supervision. This poses an immediate risk to the health, safety, and personal rights of children in care.
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Director provided copy of gate work order during visit. Summaries of what the staff's understanding of Personal Rights will be submitted by POC date.
Type A
01/23/2023
Section Cited
CCR101229(a)(1)

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101229(a)(1) Responsibility for Providing 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 observation was not met as evidenced by:
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Per Director, preschool has had a meeting already to discuss the importance of having a physical presence in the gate section of the yard. Director will have all staff watch Supervising Children in Child Care Centers on Www.childcarevideos.org/child-care-center/operators/.
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Based on interview and record review, staff did not visual observe nor supervise as a child left the facility play yard, walked through the lobby, and make their way to the parking lot. Child was outside, unsupervised while in facilty care. This posed an immediate risk to the health, safety, and personal rights of children in care.
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Summaries of what the staff's understanding of Supervision in child care will be submitted by POC date.
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:Claudia Guangorena
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023


LIC809 (FAS) - (06/04)
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