198010180-9-13-2024-33-CC-POCA-D93QKN-20240913121438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010180
Report Date: 09/13/2024
Date Signed: 09/13/2024 12:14:42 PM

Document Has Been Signed on 09/13/2024 12:14 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 - CDC VALLEYDALE		FACILITY NUMBER:	198010180
ADMINISTRATOR/ DIRECTOR:	ELIZABETH HERNANDEZ		FACILITY TYPE:	850
ADDRESS:	5355 ENID AVENUE		TELEPHONE:	(626) 858-0527
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY: 72	TOTAL ENROLLED CHILDREN: 72	CENSUS: 12	DATE:	09/13/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:55 AM
MET WITH:	Site Supervisor, Angelica Rivera		TIME VISIT/ INSPECTION COMPLETED:	12:20 PM

NARRATIVE

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On September 13, 2024, Licensing Program Analysts (LPAs) Priscilla Ochoa and Kruz Long conducted an unannounced case management inspection for the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs were greeted by Site Supervisor Angelica Rivera, who guided LPAs on a tour of the facility. This facility is divided into 3 classrooms: Valleydale 1, Valleydale 2 and Valleydale 3. The purpose of this inspection is to follow up on a self-reported incident that occurred at the facility on 08/30/2024. LPA observed 12 children in care with 9 staff members at the facility.

Brief summary of incident: During outdoor playtime, Child #1 (C1) was running across the grassy area when (they) slipped and fell. C1 landed on (their) right arm on the cement walkway. C1 stood up with pain (their) arm. Teacher promptly attended to the C1 by applying an ice pack.

During this inspection, LPAs interviewed Staff #1 (S1), interviewed Staff #2 (S2), interviewed Staff #3 (S3) and Child #1 (C1),

Based on interviews and observations conducted there was no corroborating information to determine that there was a lack of supervision during this incident. LPAs toured the outside area where the incident occurred and did not observe any tripping hazards. All reporting requirements were met. There are no deficiencies being cited at this time.

A notice of site visit was given and must remain posted for 30 days during facility’s hours of operation. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and a copy of this report was provided, along with appeal rights to Site Supervisor, Angelica Rivera.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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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