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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019610
Report Date: 09/13/2024
Date Signed: 09/13/2024 02:50:20 PM


Document Has Been Signed on 09/13/2024 02:50 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 HEAD START FULL DAYFACILITY NUMBER:
198019610
ADMINISTRATOR:DEBORAH SLOBOJANFACILITY TYPE:
850
ADDRESS:203 S. AZUSA AVETELEPHONE:
(626) 858-0527
CITY:WEST COVINASTATE: CAZIP CODE:
91790
CAPACITY:140CENSUS: 30DATE:
09/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Site Supervisor, Cecilia NoriegaTIME COMPLETED:
02:55 PM
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On September 13, 2024, Licensing Program Analysts (LPAs) Priscilla Ochoa and Kruz Long conducted an unannounced case management inspection for the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs were greeted by Site Supervisor, Cecilia Noriega, who guided LPAs on a tour of the facility. The purpose of this inspection is to follow up on a self-reported incident that occurred at the facility on 06/28/2024 before the facility closed for summer break. This facility has 4 classrooms: Classroom 7 – 10. LPA observed 30 children in care with 7 staff members.

Brief summary of incident: Child #1 (C1) was running on the outside playground and bumped into Child #2 (C2). C1 tripped and fell. C1’s face and glasses hit the ground causing a cut to the middle of the forehead.

During this inspection, LPAs interviewed Staff #1 (S1), Staff #2 (S2). LPAs attempted to interview C1 and C2 , but C1 and C2 are no longer in the program. LPAs requested child roster and staff contact information be email to LPA P. Ochoa.

On 8/14/24, LPA P. Ochoa interviewed Adult #1 (A1) over the phone.

At this time, this incident required further investigation.

A notice of site visit was given and must remain posted for 30 days during facility’s hours of operation. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and a copy of this report was provided, along with appeal rights to Site Supervisor, Cecilia Noriega.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3379
LICENSING EVALUATOR NAME: Priscilla OchoaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024
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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