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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191599338
Report Date: 02/05/2020
Date Signed: 02/05/2020 11:01:49 AM

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 HEAD START-WHITCOMBFACILITY NUMBER:
191599338
ADMINISTRATOR:PAULINE ABU-TAYEHFACILITY TYPE:
850
ADDRESS:350 W. MAUNA LOATELEPHONE:
(626) 914-0149
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:44CENSUS: DATE:
02/05/2020
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Beatrice MayorquinTIME COMPLETED:
11:15 AM
NARRATIVE
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An unannounced Case Management Annual Continuation visit was conducted by Licensing Program Analysts (LPA's) Bardo Baluyot and Lissete Gonzalez for the purpose of reviewing staff and children's files. Options Head Start main office is located at: 1330 Portrero Ave, South El Monte 91733. LPA's met with Beatrice Mayorquin, Child and Family Services Supervisor.

Staff and children's records were reviewed and found to be complete.
There were no deficiencies observed on this date in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes.

Exit interview was conducted with Supervisor. Appeal rights and procedures explained.

A copy of this report was provided.

Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
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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