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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000580
Report Date: 12/06/2023
Date Signed: 12/06/2023 02:41:13 PM


Document Has Been Signed on 12/06/2023 02:41 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:OPTIONS STATE HEADSTART -WALNUT/DIAMOND/HOLLINGWORFACILITY NUMBER:
198000580
ADMINISTRATOR:DEBORAH SLOBOJANFACILITY TYPE:
850
ADDRESS:3005 EAST HOLLINGWORTH STREETTELEPHONE:
(909) 594-8509
CITY:WEST COVINASTATE: CAZIP CODE:
91792
CAPACITY:24CENSUS: 10DATE:
12/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Shioban Barela (Associate Teacher)TIME COMPLETED:
02:45 PM
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On 12/06/23, Licensing Program Analysts (LPAs) Kruz Long and Monique Ayala conducted an unannounced case management inspection. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs met with Shioban Barela (Associate Teacher) who guided LPAs on a tour of the facility. LPAs observed 10 children with 2 staff members.

The purpose of the visit is to follow up on an incident that occurred on 12/01/23 and was reported to the department on 12/04/23 (reported timely). The self reported incident is regarding personal rights.

During this inspection, LPAs interviewed Staff #2 (S2) and Child #2 (C2) to Child #5 (C5).

There are no deficiencies being cited today. The incident requires further investigation.

An exit interview was conducted and a copy of this report was provided to Shioban Barela (Associate 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: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
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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