<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017957
Report Date: 06/01/2023
Date Signed: 06/01/2023 12:09:56 PM

Document Has Been Signed on 06/01/2023 12:09 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CHILDREN'S CENTER AT CALTECHFACILITY NUMBER:
198017957
ADMINISTRATOR:SUSAN WOODFACILITY TYPE:
830
ADDRESS:1200 E. CALIFORNIA BLVDTELEPHONE:
(626) 395-6860
CITY:PASADENASTATE: CAZIP CODE:
91125
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 22DATE:
06/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:54 AM
MET WITH:Olivia Garcia - Associate DirectorTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection for the purpose of following up on an incident reported to the Department on 05/16/2023. Upon arrival, at 10:50am, LPA met with Associate Director Olivia Garcia, to whom the purpose of the inspection was explained. At 11am, LPA was led on a tour of the facility, at which time children were present during the inspection. Director Susan Wood arrived during inspection at 11:35am.

Census was taken. 22 children with 7 staff members

On 05/16/2022, an incident was reported to the Departement of a child was walking in the yard and losing balance. When child fell, they hit their right eyebrow on a platform riser corner that is in the yard. The child required medical attention. Per Staff #1, child had their injury glued shut and child has returned to school. LPA observed child playing during inspection. During interview with staff, it was explained that the child has just started walking and and is still gaining core strength. Staff #2 who witnessed the incident stated that the child was walking and lost balance. Staff #1 explained that the cement riser has a platform made of Solid Core which is a type of wood fiber encased in recycled plastic material. LPA was able to observe the area where the injury took place. The riser is approximately 7 inches off the ground and is typically used as a rest spot, seat, or platform to assist with children pulling them self up. It is on the edge of the cement floor, separating the grass. Documents were obtained in the form of Solid Core information sheet, incident report, ouch report, and pictures were taken.

Based on the information obtained and observation of yard area, LPA determined that there was adequate supervision on the day of injury and it was not possible to prevent the injury from happening. Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit.

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 conducted with the Director Susan Wood, 11:55am. Copy of Report provided.


END OF REPORT
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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 1