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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003398
Report Date: 05/09/2019
Date Signed: 05/09/2019 03:13:54 PM

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 EDUCATIONAL CENTER, CALTECH/JPL COMMUNITYFACILITY NUMBER:
198003398
ADMINISTRATOR:CHRISTY WATERMANFACILITY TYPE:
840
ADDRESS:471 KNIGHT WAYTELEPHONE:
(818) 790-2347
CITY:LA CANADASTATE: CAZIP CODE:
91011
CAPACITY:125CENSUS: 49DATE:
05/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Alegra InganniTIME COMPLETED:
03:30 PM
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Ana Chico, Licensing Program Analyst (LPA) conducted an unannounced Case Management Inspection. LPA met with Alegra Inganni, School Age Program Director.

The purpose for this visit is to follow up on an incident reported to the Department via phone call on 10/12/18. The Unusual Incident/ Injury Report was reported as required and involved a possible seizure. During the course of the inspection, LPA reviewed the file of subject child #1.
According to director, paramedics were called after child exhibited what may have been a possible seizure. Director stated that child did not have a history of seizures which they knew about. Test came back as negative and child returned to school the following day.

No deficiencies are being cited in accordance to Title 22 California Code of Regulations

Exit interview conducted. Notice of Site Visit must be posted for (30) days.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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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