198021210-6-1-2023-33-CC-CGRN-CSDRDM-20230601125611

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021210
Report Date: 06/01/2023
Date Signed: 06/01/2023 12:56:32 PM

Document Has Been Signed on 06/01/2023 12:56 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:	CHILD ED CTR SCHOOL AGE CHILD CARE AT CALTECH		FACILITY NUMBER:	198021210
ADMINISTRATOR:	CAIN-CHANG, LISA		FACILITY TYPE:	840
ADDRESS:	240 SOUTH MICHIGAN AVENUE		TELEPHONE:	(818) 354-3418
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY: 23	TOTAL ENROLLED CHILDREN: 23	CENSUS: 0	DATE:	06/01/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Lisa Cain-Chang		TIME COMPLETED:	01:15 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) Crystal Green conducted an announced pre-licensing site inspection today to inspect and measure the facility for capacity determination. Licensee is requesting a change of location for their existing school age program (198001578) located at 250/256 S. Michigan, Pasadena, CA 91106. Licensing staff met with Lisa Cain- Chang, Director of Operations, Allegra Inganni, Director of School-Age Programs, and Bradley Nielsen, Project Manager of Facilities for Cal Tech. No children were present during this inspection. LPA observed the main entrance to the facility to be located in the rear of the building leading into the kitchen area. At approximately 11:40 am, Licensing staff was guided through a tour of the facility. This facility will have a total of (5) rooms and a kitchen. Per Director, the rooms will be called the Art Room, Living Space Area, Block Area, Game Room, and Big Kid Room. LPA observed furniture and equipment located throughout the facility. The kitchen will be accessible to the children in care. LPA observed the kitchen to have safety latches and equipment installed. This facility will have 2 toilets and 2 sinks accessible to the children. LPA observed a restroom located next to the Block Area which contained 1 toilet and 1 sink. There is another restroom located next to the Game Room which contained 1 toilet and 1 sink. All toilets and sinks are in safe and sanitary operating conditions. Water will be accessible to children via Brita Filter water system and disposable cup, and children will also have their sippy cups. LPA did not observed cots available at the facility. The facility will not offer nap time to children in care however there is a couch available for children to rest on. The first aid kit will be available in the kitchen cabinet. The facility will be using the Game Room as a designated ill-isolation room. Ill children will utilize the restroom located next to the Game Room. Individual storage space will be available for each child which will be located outside near the entrance of the facility. Page 1 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
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 2

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: CHILD ED CTR SCHOOL AGE CHILD CARE AT CALTECH	FACILITY NUMBER: 198021210
	VISIT DATE: 06/01/2023

NARRATIVE

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All outdoor areas were observed to be surrounded by fencing. All areas around or under high climbing equipment and slides were observed to have cushion material to absorb a fall. There will be seating available for children along with shading area located outside of the Living Area.

The facility will provide snacks which be located in the kitchen area. The facility will provide transportation.

Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

The Department has received an approved for the Pasadena Fire Department. Based on measurements obtained, the capacity for the school-age program will be for twenty-three (23) children.

An exit interview was conducted with Facility Representatives.

Page 2 of 2.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
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

LIC809 (FAS) - (06/04)

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