<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597150
Report Date: 07/30/2026
Date Signed: 07/30/2026 03:13:56 PM

Document Has Been Signed on 07/30/2026 03:13 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-JELLICKFACILITY NUMBER:
191597150
ADMINISTRATOR/
DIRECTOR:		MILDRED BALDERRAMAFACILITY TYPE:
840
ADDRESS:1400 S. JELLICK AVETELEPHONE:
(626) 912-1776
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 0DATE:
07/30/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:55 PM
MET WITH:Brenda Monroy - Education SupervisorTIME VISIT/
INSPECTION COMPLETED:
03:30 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) Nolan Tcheng conducted an unannounced Case Management inspection for the purpose of citing a deficiency that was determined from an inspection on 07/28/2026. Upon arrival at 1:55pm, LPA met with Facility Representative Brenda Monroy, to whom the purpose of the inspection was explained. A tour of the facility was conducted. There were 0 children and 18 staff members. It was an in-service training day so no children were on site during the time of inspection.

On 06/30/2026, the facility had a schedule field trip for the program that took children off site. During review of sign in forms for 06/30/2026, LPA observed that there were a total of 88 children signed in that day. There were 84 children who went on the field trip, and 4 children who stayed on site. LPA reviewed the field trip sign up sheet that listed rules for the off site trip. Authorized representatives were not allowed to drop off early or pick up early from the field trip location. At least 84 children were on site before departing on the field trip, and 84 children returned to the facility site at the end of day.

The facility capacity is 80. This is a violation of capacity and fire clearance for the facility, as established during the licensing application process and fire clearance inspection. Per Facility Representative, they had multiple families do drop in sign up for the field trip. They do not normally reach that many children on any given day. The program has fluctuating enrollment numbers during the summer session. They are in the understanding that they cannot allow additional families if the capacity is reaching the limit.

LPA Tcheng informed Facility Representative Brenda Monroy that this report dated 07/30/2026, documents One Type A citation, which shall be posted for 30 consecutive days as there was immediate risk to the health, safety, and personal rights of children in care.

REPORT CONTINUES PAGE 1 of 2

Ana Chico
Nolan Tcheng
DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2026
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 4
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)
Page: 2 of 4
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-JELLICK
FACILITY NUMBER: 191597150
VISIT DATE: 07/30/2026
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
Also, LPA Tcheng informed the Facility Representative to provide a copy of this licensing report dated 07/30/2026, that documents any Type A citation, to parent/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child's file for verification.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

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

Exit interview conducted and report was reviewed with Facility Representative Brenda Monroy, at 3:10pm. Plan of correction and 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: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/30/2026 03:13 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 07/30/2026 at 02:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: OPTIONS-SURROUND CARE-JELLICK
FACILITY NUMBER: 191597150

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/31/2026
Section Cited
CCR
101161(a)

1
2
3
4
5
6
7
Limitations on Capacity
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement was not met as evidence by:
1
2
3
4
5
6
7
Per Facility Representative, they will work with enrollment for notifications on documentation stating our limitations of capacity and to plan in advance. Also to verify consistent families who will be attending on any given day. Staff training will be conducted regarding capacity adherence
8
9
10
11
12
13
14
Based on interview and record review, Licensee did not ensure that the licensed capacity of 80 was maintained when there were at least 84 children on site during a field trip day 06/30/2026. This was an immediate risk to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
during summer sessions, field trips, and school year combination days. COmmunication of head counts throughout the day will be trained. Training agenda with signatures, email to enrollment, and updated field trip permision slip notations will be sent to LPA by POC date

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Nolan Tcheng
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2026


LIC809 (FAS) - (06/04)
Page: 4 of 4