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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191599772
Report Date: 06/13/2024
Date Signed: 06/13/2024 01:42:41 PM

Document Has Been Signed on 06/13/2024 01:42 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-HEAD START-CHARTER OAKFACILITY NUMBER:
191599772
ADMINISTRATOR/
DIRECTOR:		ANTIONETTE BUSTAMANTEFACILITY TYPE:
850
ADDRESS:4949 BONNIE COVETELEPHONE:
(626) 967-1775
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY: 24TOTAL ENROLLED CHILDREN: 16CENSUS: 11DATE:
06/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Mabel Nunez, Associate TeacherTIME VISIT/
INSPECTION COMPLETED:
01:55 PM
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On 06/13/2024, Licensing Program Analyst (LPA) Kruz Long conducted an unannounced case management inspection. A COVID-19 risk assessment was conducted. LPA met with Mabel Nunez, Associate Teacher and explained the purpose of the visit. LPA observed 11 children with 3 staff member in the classroom.

The purpose of the visit is to follow up on an incident that occurred on 05/14/2024 and was reported to the department on 05/15/2024 (reported timely). The self reported incident is regarding personal rights.

During today's visit, LPA interviewed Child #3 (C3) and Child #4 (C4).

There are no deficiencies being cited today as the incident requires further investigation.

An exit interview was conducted and a copy of this report and appeal rights was provided to Mabel Nunez, Associate Teacher. A Notice of Site Visit was provided; Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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