191597000-9-8-2022-33-CC-BBAT-CJ3TQY-20220908145643

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191597000
Report Date: 09/08/2022
Date Signed: 09/08/2022 02:56:50 PM

Document Has Been Signed on 09/08/2022 02:56 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-HOLLINGWORTH SCHOOL AGE		FACILITY NUMBER:	191597000
ADMINISTRATOR:	RACHEL SILVA		FACILITY TYPE:	840
ADDRESS:	3005 E. HOLLINGWORTH STREET		TELEPHONE:	(818) 284-9935
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91792
CAPACITY:	120	CENSUS: 4	DATE:	09/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:58 PM
MET WITH:	Site Director, Noemi Paez		TIME COMPLETED:	03:15 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, Noemi Paez. LPA conducted a COVID risk self-assessment upon entry. This facility operates a morning and afternoon session from 6:30-7:30am and 1:20-6:00pm. LPA observed 1 staff with 6 children. 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. During the inspection, the maximum enrolled/present was 10. There are 3 bungalows belonging to this license. Only 1 of the 3 were in use on this date. 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's restrooms are located on school property and shared with the school. LPA evaluated general sanitation and cleanliness of facility. LPA observed a water jug available for children indoors. Carbon Monoxide and Smoke detectors were tested and are 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/lunch menus were 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. Director Noemi's First Aid/CPR certification were reviewed and expire 08/2024.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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 2

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-HOLLINGWORTH SCHOOL AGE	FACILITY NUMBER: 191597000
	VISIT DATE: 09/08/2022

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 were 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 Options For Learning main office, located at: 304 S. 1st St, Alhambra CA 91801 (626)284-9935

Exit interview conducted and report was reviewed with Site Director, Noemi Paz.

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: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2