<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191596482
Report Date: 03/08/2024
Date Signed: 03/08/2024 01:26:33 PM


Document Has Been Signed on 03/08/2024 01:26 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:OPTIONS-SURROUND CARE-MONTEREY HIGHLANDSFACILITY NUMBER:
191596482
ADMINISTRATOR:ELAIEN ONFACILITY TYPE:
840
ADDRESS:400 CASUDA CANYON DRIVETELEPHONE:
(626) 576-0938
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY:80CENSUS: DATE:
03/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Elaine On (Site Director/Teacher)TIME COMPLETED:
01:30 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
On March 08, 2024, Licensing Program Analyst (LPA) Kruz Long conducted an unannounced case management inspection. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Elaine On (Site Director/Teacher) who guided LPA on a tour of the facility. LPA observed 0 children with 1 staff members.

The purpose of the visit is to follow up on an incident that occurred on 01/04/2024 and was reported to the department on 03/04/2024. The self reported incident is regarding supervision/personal rights.

During this inspection, LPA interviewed Staff #1 (S1) and obtained the children roster.

There are no deficiencies being cited today, as the incident requires further investigation.

An exit interview was conducted and a copy of this report was provided to Elaine On (Site Director/Teacher). A Notice of Site Visit was provided; Notice of Site Visit must be posted for 30 days.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Kruz LongTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1