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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191592100
Report Date: 06/14/2019
Date Signed: 06/14/2019 11:33:27 AM

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:OPTIONS-SURROUND CARE-NORTHRUPFACILITY NUMBER:
191592100
ADMINISTRATOR:BEN PASCALEFACILITY TYPE:
840
ADDRESS:409 S. ATLANTICTELEPHONE:
(626) 281-9533
CITY:ALHAMBRASTATE: CAZIP CODE:
91803
CAPACITY:48CENSUS: DATE:
06/14/2019
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Tracy LynchTIME COMPLETED:
11:35 AM
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Licensing Program Analyst, Ana Chico, conducted an office meeting with Tracy Lynch, Division Director for Empowered Learning. The purpose for this meeting is to discuss pending documents needed to finalize and Administrative File for Options - Empowered Learning.

An updated Board Resolution dated 5/2/18 is on file and appoints Tracy Lynch as an authorized individual for Empowered Learning Programs. In addition, an updated letter requesting that records be reviewed off site was submitted for all divisions under Options for Learning, the agency.

The following forms / facility information needs to be updated specifically for Options - Empowered Learning. (with the exception of general documents for Options the Agency.)
Required Updates:
  • Employee handbook- New Mandated Reporter training must be included. Director's and/or Staff's First Aid, CPR and Health and Safety Training Verification to include Nutrition training.
  • Plan of Operation (Parent Handbook) - To include Incidental Medical Services.
  • Qualifications for Tracy Lynch to include: Immunization Record, Mandated Reporter Certificate and Health Screening
  • Letter requesting an administrative file for Empowered Learning. Options Northrup (#191592100) has been selected as the administrative association facility for this division. Letter to include a list of sites.
  • Empowered Learning job descriptions

The above will be submitted by 7/15/19. Exit interview conducted with Tracy Lynch, Division Director.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
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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