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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017737
Report Date: 10/20/2021
Date Signed: 10/20/2021 11:10:45 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- RAMONA CHURCHFACILITY NUMBER:
198017737
ADMINISTRATOR:DENISE FERNANDEZFACILITY TYPE:
850
ADDRESS:909 E. JUANITA AVENUETELEPHONE:
(626) 206-0727
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY:30CENSUS: DATE:
10/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elizabeth Fuller, TeacherTIME COMPLETED:
11:15 AM
NARRATIVE
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An unannounced Case Management visit was conducted today by Licensing Program Analyst (LPA) Bardo Baluyot to conduct interviews regarding an Unusual Incident Report submitted on 10/14/21 that involved allegations of staff "pinching" a child. LPA met with Teacher, Elizabeth Fuller who guided the LPA on a tour of the facility and provided a statement regarding the incident.

Upon LPA's arrival, there were 22 children on site ranging from 3-5 years old. Census was taken at 10:15 am. There were 4 staff present.

Upon receipt, the Licensee shall post the Notice of Site Visit and the Licensing report. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

Exit interview was conducted with Teacher, Sorel Rodriguez and a copy of the report was provided. Appeal Rights procedures also provided and explained.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
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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