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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191596482
Report Date: 09/03/2026
Date Signed: 09/03/2026 03:02:01 PM

Document Has Been Signed on 09/03/2026 03:02 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-SURROUND CARE-MONTEREY HIGHLANDSFACILITY NUMBER:
191596482
ADMINISTRATOR/
DIRECTOR:		MILDRED BALDERRAMAFACILITY TYPE:
840
ADDRESS:400 CASUDA CANYON DRIVETELEPHONE:
(626) 576-0938
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 15DATE:
09/03/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Brittany Cotero - Substitute TeacherTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced subsequent Case Management inspection to follow up on an incident submitted to the Department on 08/12/2026. Upon arrival at 2pm LPA met with Facility Representative Brittany Cotero, to whom the inspection was explained. A tour of the facility was conducted and census was taken. There were 15 children with 2 staff members.

On 07/31/2026, the facility was notified that an incident in June 2026 may have occurred. Parent of Child #1 (C1) informed the facility that C1 disclosed that Staff #3 (S3) had disciplined them in a manner that violated their personal rights. LPA conducted initial inspection of this follow up on 08/20/2026.

During interview with Staff #1, they explained that they were told by other children that C1 was trying to take a toy away from another child. They were then informed that S3 grabbed C1’s hand in order to stop him. During an interview with Staff #3, they explained, “On a table, there were two students who were talking and playing with the little blocks. They were arranging them and knocking them down. I was there. They were happy, taking turns knocking down… another [child #1] came in attempting to knock it. I did do my hand to say stop (S3 described it as how to say "stop" in sign language). After that [C1] cried, but I did my hand like this.” LPA requested more elaboration on the “stop” sign language, and S3 stated that they did the sign in front of C1 as they were reaching out. “I know [their] hand did not get stuck in it but he may have been close enough.” Staff #4 was interviewed about the situation. They did not observe it themselves but they also were told by others that S3 had grabbed C1’s hand. Per S4, they said S3 “demonstrated how [they] dropped [their] hand and arm to stop the child” which was the same “stop” gesture that S3 showed during their interview.

Child #2 was interviewed due to being present and a witness to the incident. Per Child #2, when asked about the incident, they stated "I don't know if it was the angle but [S3] was covering [C1], so I don't know know if [they] grabbed [C1] or didn't." Child #1 was not present for interview on 08/20/2026, and today 09/03/2026. REPORT CONTINUES PAGE 1 of 2

Ana Chico
Nolan Tcheng
DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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-SURROUND CARE-MONTEREY HIGHLANDS
FACILITY NUMBER: 191596482
VISIT DATE: 09/03/2026
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Based on the information gathered during interviews conducted, there is conflicting information regarding what occurred between Staff #3 and Child #1, and if Staff #3 physically contacted C1. Staff interviews and Child interview could not confirm that they observed any violation of personal rights. An Advisory Note will be provided to discuss best practices.

At this time, no deficiencies are being cited in accordance with California Title 22 Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Facility Representative Brittany Cotero, at 3:15pm. Copy of report provided.

END OF REPORT PAGE 2 of 2

NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Nolan Tcheng
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
LIC809 (FAS) - (06/04)
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