Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001578
Report Date: 04/21/2017
Date Signed 04/21/2017 01:04:15 PM

COMPREHENSIVE INSPECTION
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:
198001578
ADMINISTRATOR:SHAKE AMZOYANFACILITY TYPE:
840
ADDRESS:250-56 S. MICHIGANTELEPHONE:
(818) 354-3418
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:42CENSUS: 0DATE:
04/21/2017
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH: Sheri Whalen, Human Resource Coordinator,TIME COMPLETED:
01:00 PM
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A case management -Annual Continuation inception was made on this date to review staff files based on a Annual Random inspection made at the above address on 03/30/2017. Met with Sheri Whalen, Human Resource Coordinator, whom the purpose of the inception was explained.

This inspection is being done at the main office for Child Educational Center, Caltech/JPL located at 140 Foothill Blvd., La Canada, CA 91011 because all staff files are kept at this office, not at site locations.

A review of the staff files indicated on LIC 859 has been completed today and all files are complete with licensing information.


Exit interview was conducted with Sheri Whalen, Human Resource Coordinator.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2017
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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