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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017640
Report Date: 09/24/2021
Date Signed: 09/24/2021 09:24:31 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 PRESCHOOL-AZUSA HIGHFACILITY NUMBER:
198017640
ADMINISTRATOR:DEBORAH SLOBOJANFACILITY TYPE:
850
ADDRESS:240 N. CERRITOS AVENUETELEPHONE:
(626) 854-3449
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY:48CENSUS: 11DATE:
09/24/2021
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Monica Delgado, StaffTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Thelma Razo conducted an unannounced Collateral visit and met with staff Monica Delgado. LPA stated the purpose of the visit is to interview Child#1 regarding a complaint that was filed at another licensed facility.

There were no deficiencies cited during today's visit.

The Notice of Site Visit (LIC 9213) must be posted for 30 days during the hours of operation after a site visit is conducted by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with facility staff.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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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