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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017763
Report Date: 08/24/2022
Date Signed: 08/24/2022 03:29:31 PM


Document Has Been Signed on 08/24/2022 03:29 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:OPTIONS-HEADSTART/CDC-EKSTRANDFACILITY NUMBER:
198017763
ADMINISTRATOR:CARMEN RAMOSFACILITY TYPE:
850
ADDRESS:440 N. WALNUT AVETELEPHONE:
(626) 858-0527
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:45CENSUS: 13DATE:
08/24/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
02:48 PM
MET WITH:Site Director, Carmen NelsonTIME COMPLETED:
03:45 PM
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At approximately 2:45 PM on this day, Licensing Program Analyst (LPA) Bardo Baluyot conducted an unannounced Case Management Inspection. The purpose of this inspection is to follow up on a COVID-19 outbreak at the facility with Registered Nurse from Department of Public Health, (DPHRN), Joseph Tran. A risk assessment was conducted prior entering the facility. Upon arrival LPA was greeted by Site Director, Carmen Nelson. LPA observed 13 children in care with 5 staff.

DPH inspection was conducted yesterday (8/23/22) but LPA was unable to attend. Site Director contacted via phone Education Coordinator, Carmen Estrada who participated in the initial visit. Per Ms. Estrada, during the inspection, DPHRN advised that the facility implement, air purifiers instead of fans and when eating to ensure there is sufficient space between the children and if there is an ill child or staff the isolation area is recommended to be outdoors if the facility is not able to provide a designated area. Per DPHRN Tran, all recommendations will be sent to Ed Coordinator Carmen Estrada via email and forwarded to LPA Baluyot.

Prior to arriving at the facility, LPA reviewed the facilities profile and did not observe any COVID-19 cases reported to the department. Per Coordinator Estrada, she will follow up with Division Director, Stacy Greener who oversees all reports to Licensing. LPA reminded Coordinator Estrada that any/all unusual incident reports, including COVID-19 cases, must be reported to the department following Title 22 Regulations. LPA provided licensee with a copy of Reporting Requirement regulation.

An exit interview was conducted, and a copy of this report was provided to Site Director, Carmen Nelson along with Notice of Site Visit and Appeal Rights.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022
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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