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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004436
Report Date: 05/11/2026
Date Signed: 05/11/2026 11:58:44 AM

Document Has Been Signed on 05/11/2026 11:58 AM - 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-STATE PRESCHOOL-HURLEYFACILITY NUMBER:
198004436
ADMINISTRATOR/
DIRECTOR:		DEBORAH SLOBOJANFACILITY TYPE:
850
ADDRESS:535 S. LAURA AVENUETELEPHONE:
(626) 839-3878
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 16DATE:
05/11/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Richard Mata - Education SupervisorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection of a incident that was reported to the Department on 04/30/2026. Upon arrival at 8:40am, LPA met with Facility Representative Richard Mata, to whom the purpose of the inspection was explained. A tour of the facility was conducted and census was taken. There were 16 children with 4 staff members.

On 04/30/2026, Child #1 (C1) was playing on the play structure when they fell and hit their head on the "soft-crete" (cushioned material). C1 sustained multiple injuries from the fall. During today's inspection, interviews were conducted with three staff members. Interview with Child #1 was not conducted during today's inspection due to absence.

Staff interviews stated that C1 fell from the curved ladder next to the slide of the play structure. All interviews corroborated that there were three staff members present on the play yard when the child fell. Staff #1 explained that it was going to be transition time to go inside, when they saw Child #1 fall from the structure, immediately going over to check on them. Staff #2 corroborated that they were getting ready to go inside, and that Staff #1 immediately responded to child falling from structure. Staff #3 also corroborated that they were cleaning up to go inside, and lining up by the "gazebo" and they observed Child #1 fall from the structure because they tripped over their feet as they were crawling up the curved ladder. Staff all stated that first aid was provided and that the parent was contacted, who picked C1 up from facility and took them to receive additional medical evaluation. Child has since returned to care and has been cleared to join normal activities. Staff #3 states that they ensure to go over rules and safety with children before they play outside, children use ladders one at a time, and staff are always spaced out to provide supervision.

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: 05/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2026
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-STATE PRESCHOOL-HURLEY
FACILITY NUMBER: 198004436
VISIT DATE: 05/11/2026
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Based on the information gathered, there was adequate supervision when the child sustained the injuries and staff immediately provided first aid. Parent was contacted and child was able to receive additional medical evaluation to be cleared before returning to care the next day. Incident and injury were both documented in Hubbe. There were no observed issues/defects with the play structure and LPA was able to informed by Options For Learning Physical Plant Facility Supervisor, that play structure was age appropriate to children being served. The incident appears to be an unusual accident. There was nothing the facility could have done to prevent it from occurring.

There are no citations 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 Richard Mata, at 11:55am. Copy of Report provided.

END OF INTERVIEW PAGE 2 of 2

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

DATE: 05/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2026
LIC809 (FAS) - (06/04)
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