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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003376
Report Date: 03/17/2026
Date Signed: 03/17/2026 03:07:30 PM

Document Has Been Signed on 03/17/2026 03:07 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-WILSONFACILITY NUMBER:
198003376
ADMINISTRATOR/
DIRECTOR:		MILDRED BALDERRAMAFACILITY TYPE:
840
ADDRESS:8317 E. SHEFFIELD RD.TELEPHONE:
(626) 287-7710
CITY:SAN GABRIELSTATE: CAZIP CODE:
91775
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 8DATE:
03/17/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Sylvia Weisse - Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection, for the purpose of following up on an incident reported to the Department on 02/27/2026. Upon arrival at 1:45pm, LPA met with Facility Representative Sylvia Weisse. A tour of the facility was conducted and census was taken. There were 8 children and 2 staff members during the time of tour.

On 02/26/2026, Child #1 got out of school at 2pm and arrived at the facility. Facility is located on the campus of Wilson Elementary School, where the child is enrolled. Child #1 (C1) spoke with other children in care to show them an item in their backpack. Staff #1 intercepted the child and had them show them their backpack, which carried an unloaded "BB gun."

LPA spoke with Staff #1 (S1) who stated that they verified that there was no ammo/pellets with it and that it had a orange tip, confirming it was an airsoft/BB gun. They placed the item in the teacher's cabinet which has a lock, making it inaccessible to children in care. Parent was contacted and C1 was soon picked up at 3pm by an authorized representative, who was given the item to take home. Parent confirmed that C1 did own a BB gun but was unaware they brought it to school. Per S1, their supervisor, once informed of the incident, contacted the elementary school principal so they were aware of the situation. San Gabriel Unified School District was informed and conducted meetings with the child and parent, as well as S1.

S1 described C1 and how they were at the program. Per S1, they believe the BB gun was brought to school because they wanted to show it off to others, not for intentions to use or harm anyone. Child is still enrolled but they have not been attending so no interview was able to be conducted during today's inspection. Moving forward, C1's backpack will be checked every day they arrive at the facility. Safety and appropriateness is being reminded and discussed with children in care, regularly.

REPORT CONTINUES PAGE 1 of 2

NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Nolan Tcheng
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2026
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-WILSON
FACILITY NUMBER: 198003376
VISIT DATE: 03/17/2026
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Based on the information gathered during today's inspection, Facility and staff followed appropriate measures and responded accordingly. They have established new procedures for when Child #1 attends and are practicing reminders with the children as a whole, in order to promote safety. Staff #2 (S2) informed LPA that resources were offered to the family if they believed it was needed for Child #1, but S2 says it is up to them if they wish to accept them.

There was no violation of California Title 22 Regulations. No deficiencies are being provided during today's inspection.

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

Exit interview conducted and report was reviewed with Facility Representative Sylvia Weisse, 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: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC809 (FAS) - (06/04)
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