304370390-1-19-2023-06-CC-PRIS-CN8VFE-20230119152350

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370390
Report Date: 01/19/2023
Date Signed: 01/19/2023 03:25:04 PM

Document Has Been Signed on 01/19/2023 03:25 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	OPTIONS SURROUND CARE-MACY		FACILITY NUMBER:	304370390
ADMINISTRATOR:	ENRIQUEZ, ERIKA		FACILITY TYPE:	840
ADDRESS:	2301 WEST RUSSELL STREET		TELEPHONE:	(562) 690-4671
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	40	CENSUS: 9	DATE:	01/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Natasha Maldonado Aubry, Site Director		TIME COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) P Rivas conducted an annual inspection and met with Site Director Natasha Madonado Aubry. Upon entrance LPA was advised that children begin program about 3:10pm. and that Site Director is only staff. Ms. Maldonado- Aubry's supervisor was called but was unable to come meet with LPA.. LPA conducted physical plant tour and staff interview. Due to time constraints and need for staff to provide care and supervision to children, annual inspection will be completed at a later date. During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Snacks are prepared on site; Food prep areas were clean and sanitary. Food is properly stored. Menus were posted where they could be reviewed by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by water pitcher and disposable cups. The children's bathrooms are clean and sanitary. The facility has conducted an emergency drill within the past six months 01/12/23.. The facility has has working carbon monoxide detectors and fire extinguisher fire extinguishers That meet the State Fire Marshall Requirements. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility During today's inspection in the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. An Inspection and exit interview was completed with Site Supervisor Natasha Maldonado Aubry. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a page 1 of 2

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OPTIONS SURROUND CARE-MACY	FACILITY NUMBER: 304370390
	VISIT DATE: 01/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

page 2

copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2