198017957-11-4-2022-33-CC-VMGA-CKUSLT-20221104135852

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017957
Report Date: 11/04/2022
Date Signed: 11/04/2022 01:58:55 PM

Document Has Been Signed on 11/04/2022 01:58 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:	CHILDREN'S CENTER AT CALTECH		FACILITY NUMBER:	198017957
ADMINISTRATOR:	SUSAN WOOD		FACILITY TYPE:	830
ADDRESS:	1200 E. CALIFORNIA BLVD		TELEPHONE:	(626) 395-6860
CITY:	PASADENA	STATE: CA	ZIP CODE:	91125
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 20	CENSUS: 14	DATE:	11/04/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Susan Wood - DIrector		TIME COMPLETED:	02:05 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Nolan Tcheng and Veronica Martinez-Garza conducted an unannounced case management inspection to follow up on an incident that reported to the Department on 08/12/2022. LPAs met with Director Susan Wood, who provided LPAs a tour of the facility inside and outside.

Census was taken. There were 8 children and 4 staff in Eloisa's Bunnies (Infant), and 6 children and 2 staff in Tricia's Bunnies (Infant).

On 08/12/2022, an incident was reported to the Department where a child was riding a "Y-bike" during outside play. The wheels on the y-bike got stuck and the child fell forward. Child sustained a scrape on their chin and their mouth was bleeding, with staff unable to find source of bleeding. Facility informed Department that the parent stated the child had a cracked tooth and had to have a procedure completed in order to remove it due to severity of crack. LPAs observed the y-bikes and obtained pictures. They were observed to be in good condition and free of any defects. Child file review was conducted and LPAs observed facility incident report, licensing incident report, and medical service invoice for child's procedure. LPA is providing an Advisory Note (LIC9102) Technical Assistance regarding the incident.

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 Director Susan Wood at 1:53pm. Copy of Report was provided.

END OF REPORT

Ana Chico
Veronica Martinez-Garza
	DATE: 11/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

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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