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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019784
Report Date: 03/05/2025
Date Signed: 03/05/2025 04:02:44 PM

Document Has Been Signed on 03/05/2025 04:02 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:ACADEMY AT PASADENA, THEFACILITY NUMBER:
198019784
ADMINISTRATOR/
DIRECTOR:
KARA LEWISFACILITY TYPE:
850
ADDRESS:700 E GREEN STTELEPHONE:
(626) 578-7300
CITY:PASADENASTATE: CAZIP CODE:
91101
CAPACITY: 74TOTAL ENROLLED CHILDREN: 0CENSUS: 31DATE:
03/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:24 PM
MET WITH:Director Kara LewisTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced Case Management inspection due to an incident that occurred on 2/20/25 and was reported to the Department on 2/21/25. A risk assessment was conducted. LPA met with Director Kara Lewis to whom the reason for the visit was explained. Director guided LPA on a tour of the facility. There were 31 children present and 6 staff. The facility was observed to be operating within the license capacity limitations.

On 2/21/25 an unusual incident was reported to department regarding an injury that had occurred with a 3 year old child. The child was running in the play yard to put his water bottle away and tripped on his own feet and fell face forward landing on his forehead. Incident was observed by Teacher and immediately notified assistant director. Assistant director applied ice pack for 30 minutes and monitored the child. Ouch report was filled out digitally through Origami app which is sent to parent right away. Child was monitored and began vomiting. Parents were contacted immediately and child vomited 2 more times before parents picked up. Child was brought to Huntington ER and diagnosed with concussion. Child stayed home Friday 2/21/25 and was cleared to return to school with no restrictions on 2/24/25.

LPA interviewed Director, obtained ouch report, doctors note, and observed the outdoor play yard during today's visit. No hazards were observed in the play yard where the child had tripped.

Based on information obtained during this visit, no follow up is necessary regarding the incident reported. No deficiencies are being cited at this time.

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 Kara Lewis.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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