191595710-9-21-2022-33-CC-BBAT-CJGULG-20220921154042

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191595710
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:41:08 PM

Document Has Been Signed on 09/21/2022 03:41 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-OSWALT		FACILITY NUMBER:	191595710
ADMINISTRATOR:	DOLORAS MARTINEZ		FACILITY TYPE:	840
ADDRESS:	19501 SHADOW OAK DR.		TELEPHONE:	(626) 964-7358
CITY:	WALNUT	STATE: CA	ZIP CODE:	91789
CAPACITY:	40	CENSUS: 15	DATE:	09/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Teacher Assistant, Promila Sawhney		TIME COMPLETED:	03:50 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 Teacher Assistant, Promila Sawhney. LPA conducted a COVID risk self-assessment upon entry. This facility operates from 6:30-9:30am and 1-6pm Tuesday through Friday, Monday 6:30-8:30 and 12-6pm. LPA observed 2 staff with 1 child upon arrival. LPA found that facility is operating within ratio. Care and supervision was evaluated to determine if the basic needs of children are met. LPA observed during this inspection that facility is in compliance of this. LPA reviewed sign in/outs sheets and children's roster. There was a total census of 14 at the end of the inspection. There is one portable belonging to this license which was identified on facility sketch and inspected. Facility was granted a capacity decrease to 40 on 2/23/2022 and facility reduced to a single portable. The second portable is currently off-limits and being used as a storage space. 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. 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 water jug and cups. Carbon Monoxide/Smoke detector was tested and is functioning. Outdoor area and equipment was inspected for safety, cushioning material, condition and age appropriateness. Required shade and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. Outdoor drinking water is provided in form of water fountains. Snack menu was reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation area was inspected. A review of cleaning and food supply storage areas was made. LPA inspected First Aid Kit supplies. CPR/First Aid certification for Ms. Wozniak expires 2/27/2023.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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-OSWALT	FACILITY NUMBER: 191595710
	VISIT DATE: 09/21/2022

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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 Section 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.

All children's medications were observed to be locked in a secure location an were within their expiration dates. LPA also reviewed the parent authorization and physician's forms and found them to be complete. LPA reminded staff that two of the medications were within 1-2 months of their expiration dates.

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 For Learning Surround Care main office located at: 304 S. 1st St, Alhambra CA 91801 (626)284-9935

Exit interview conducted and report was reviewed with Teacher Assistant, Promila Sawhney.

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.

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: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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