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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597150
Report Date: 09/13/2022
Date Signed: 09/13/2022 03:54:28 PM


Document Has Been Signed on 09/13/2022 03:54 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-JELLICKFACILITY NUMBER:
191597150
ADMINISTRATOR:DARLEEN JUAREZFACILITY TYPE:
840
ADDRESS:1400 S. JELLICK AVETELEPHONE:
(626) 912-1776
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY:80CENSUS: 18DATE:
09/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Arely Garcia, Site SupervisorTIME COMPLETED:
04:00 PM
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An unannounced Required Annual site inspection was conducted by Licensing Program Analyst (LPA), Bardo Baluyot, who met with Teacher, Arely Garcia. LPA conducted a COVID risk self-assessment upon entry. LPA conducted a complete tour of the facility. Program currently operates an AM session from 6:30 AM to 9:45 AM and in the afternoon from 1:15PM to 6:00PM.

Rooms identified on facility sketch were inspected. Only Portable #1 one was being used at this time. Per staff, Enrichment Program began using Room #2 last year and operates under a separate facility number. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with a sink, toilet were inspected. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed.

Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water.

Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were inspected for safety and cleanliness. A review of cleaning and food supply storage areas was made.

First Aid supplies were inventoried. Site Director's First Aid/CPR certification were reviewed and expires 8/2024. Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
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-JELLICK
FACILITY NUMBER: 191597150
VISIT DATE: 09/13/2022
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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

After a complete inspection of the facility, there were no deficiencies observed on this date according to California Code of Regulations Title 22 Division 12.

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

Exit interview conducted and report was reviewed with the Site Director, Arely Garcia.

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.

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 ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC809 (FAS) - (06/04)
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