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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017957
Report Date: 08/28/2024
Date Signed: 08/28/2024 01:37:07 PM

Document Has Been Signed on 08/28/2024 01:37 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:CHILDREN'S CENTER AT CALTECHFACILITY NUMBER:
198017957
ADMINISTRATOR/
DIRECTOR:		SUSAN WOODFACILITY TYPE:
830
ADDRESS:1200 E. CALIFORNIA BLVDTELEPHONE:
(626) 395-6860
CITY:PASADENASTATE: CAZIP CODE:
91125
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 17DATE:
08/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Susan Wood - DirectorTIME VISIT/
INSPECTION COMPLETED:
01:50 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 Analysts (LPAs) Nolan Tcheng and Priscilla Ochoa conducted an unannounced Case Management inspection for the purpose of following up on an unusual incident report submitted to the Department on 08/27/2024. Upon arrival at 11:40am, LPA met with Director Susan Wood, to whom the purpose of the inspection was explained. Tour of the facility was provided. There were children present during the time of inspection.

Census was taken. There were 17 children present with 9 staff members.

On 08/26/2024, an incident took place at the facility, where a child in care was left outside in the play area without adult supervision. A staff member returning from their break observed the child by themselves outside in the sandbox and brought them back in with the group.

Interviews all corroborated that the incident took place, and that it occurred at approximately 3-3:30pm, during the transition from outside play to snack time, inside. Interviews also corroborated that the child was left outside for a total of 2-3 minutes before they rejoined the group. Staff stated that there was shade in the area that the child was left. LPAs observed the area and took pictures. During today's inspection, it was confirmed that the were was a child left unattended and did not have adult supervision. This violation will be issued a Type A deficiency, addressed on the attached LIC809D.

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. REPORT CONTINUES PAGE 1 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CHILDREN'S CENTER AT CALTECH
FACILITY NUMBER: 198017957
VISIT DATE: 08/28/2024
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
26
27
28
29
30
31
32
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director Susan Wood, at 1:30pm. Plan of corrections developed and copy of report provided.

END OF REPORT PAGE 2 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/28/2024 01:37 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 08/28/2024 at 01:22 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: 198017957

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2024
Section Cited
CCR
101429(a)(1)

1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision for Infants
(1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Per Director, they will host a staff meeting to review supervision and transition protocols. Staff will watch the "Supervising Children in Child Care Centers" at www.ccld.childcarevideos.org and will write summaries regarding the video. Facility will submit staff meeting agenda, staff sign
8
9
10
11
12
13
14
Based on record review and interview, licensee did not ensure that CHild #1 was provided visual supervision at all times, resulting in the child being left unattended on the outdoor play area. This was an immediate risk to the health, safety, and personal rights of child in care.
8
9
10
11
12
13
14
in attendance sheet, and summaries of the supervision video, to LPA by POC.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Ana Chico
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3