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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000580
Report Date: 12/12/2019
Date Signed: 12/12/2019 10:04:56 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 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: 12DATE:
12/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Lisa MadrigalTIME COMPLETED:
10:15 AM
NARRATIVE
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An unannounced annual random site inspection was conducted by Licensing Program Analysts (LPAs) Ariel Cazares and Bardo Bayulot. LPAs met with Site Supervisor Lisa Madrigal. Upon arrival, LPAs observed 12 children present (1 additional child observed signed in was in a Physical Therapy during the inspection and was noted on a separate sign in/out sheet) with 2 staff. LPA conducted a complete tour of the facility. Program currently operates a Head Start session in the mornings from 8:15 AM to 11:45 AM and a State Preschool session in the afternoon from 12:45 to 3:45PM.

LPAs inspected the classroom. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. There are cubbies and hooks for children's belongings. Age appropriate sinks and toilets were inspected for availability and good repair. Availability of indoor drinking water was observed in form of water fountains attached to children's sinks. First aid and emergency supplies were observed in the classroom. The carbon monoxide detector was tested and found to be operational.

Menus were observed posted in the facility and reviewed. The refrigerator and food preparation area was inspected for cleanliness and safety. The AM session is offered both breakfast and lunch; the PM session is offered lunch.

Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness. There were no bodies of water observed on this date. LPAs did not observe an area that would provide constant shade when outdoors. Per Site Supervisor, the tree that provided shade was taken down. The facility will need to provide a shaded rest area for children when outdoors. Drinking water is taken outdoors via a water bottles and cups.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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 3
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 STATE HEADSTART -WALNUT/DIAMOND/HOLLINGWOR
FACILITY NUMBER: 198000580
VISIT DATE: 12/12/2019
NARRATIVE
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This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s personnel and administrative records. 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.

Main staff and children's files are stored at the Options State Preschool main office, located at: 18455 E. Rail Road Ave, City of Industry, CA 91748. (626) 854-3449. No files were reviewed on this date.

INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

See 809-D for cited deficiencies.

An exit interview was conducted with Site Supervisor Lisa Madrigal. A copy of this report and appeal rights and procedures were provided.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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 STATE HEADSTART -WALNUT/DIAMOND/HOLLINGWOR
FACILITY NUMBER: 198000580
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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The outdoor activity space shall be situated to:
Provide a shaded rest area for the children.

This requirement has not been met as evidenced by LPAs observations of the outdoor playground and no shaded rest area. This poses a potential risk to the health and safety of children in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3