191592880-9-28-2022-33-CC-BBAT-CJPTS6-20220928145837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191592880
Report Date: 09/28/2022
Date Signed: 09/28/2022 02:58:43 PM

Document Has Been Signed on 09/28/2022 02:58 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:	OPTIONS-SURROUND CARE-YBARRA		FACILITY NUMBER:	191592880
ADMINISTRATOR:	REBECCA LOMAS		FACILITY TYPE:	840
ADDRESS:	1300 SO. BREA CANYON CUTOFF		TELEPHONE:	(909) 598-3154
CITY:	WALNUT	STATE: CA	ZIP CODE:	91789
CAPACITY:	40	CENSUS: 16	DATE:	09/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Teacher Bertha Sequeida		TIME COMPLETED:	03:10 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	An unannounced Required Annual site inspection was conducted by Licensing Program Analyst (LPA), Bardo Baluyot, who met with Site Director, Bertha Sequeida. This facility operates an AM session from 6:30-8 and PM session from 1-6. There was 1 child in care with 2 staff upon LPA's arrival. Final census was 16 children at the end of the inspection. Room identified on facility sketch was inspected. Furniture and equipment were inspected for age appropriateness and its condition. Telephone service, heating, lighting and ventilation were evaluated. Storage space/area for children's belongings was inspected. Children share restroom with the school The condition and age appropriateness of children’s sinks and toilets were inspected. LPA evaluated general sanitation and cleanliness of facility. Availability of indoor drinking water was observed in form of a jug dispenser. Outdoor area and equipment was inspected for safety, cushioning material, condition and age appropriateness. Required shade, drinking water (water fountain outdoors) and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. Snack/Meal menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness. A review of cleaning and food supply storage areas was made. LPA inspected First Aid kit’s supplies and completeness. A review of the facility’s medication policy and records were made. LPA found that the Incidental Medical Services (IMS) plan for each of the 3 children currently receiving IMS were complete and within their expiration dates. Ms. Sequeida's CPR/First Aid certification were reviewed and expire on 8/13/22

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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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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: OPTIONS-SURROUND CARE-YBARRA	FACILITY NUMBER: 191592880
	VISIT DATE: 09/28/2022

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

No deficiencies cited during today's visit in accordance with Title 22 California Code of Regulations.

No children or staff files were reviewed during today's visit. Files are kept in the
Options State Preschool's main office located at: 304 South 1st St. Alhambra 91801 Telephone # (626) 284-9935

Exit interview conducted and report was reviewed with Site Director, Bertha Sequeida

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22 Regulations.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

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