198010785-9-21-2022-33-CC-BBAT-CJGQYW-20220921123550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010785
Report Date: 09/21/2022
Date Signed: 09/21/2022 12:35:57 PM

Document Has Been Signed on 09/21/2022 12:35 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	OPTIONS-STATE PRESCHOOL-EVERGREEN		FACILITY NUMBER:	198010785
ADMINISTRATOR:	DEBORAH SLOBOJAN		FACILITY TYPE:	850
ADDRESS:	12928 PUTNAM		TELEPHONE:	(562) 696-1243
CITY:	E. WHITTIER	STATE: CA	ZIP CODE:	90602
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 16	DATE:	09/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:38 AM
MET WITH:	Teacher, Monica Velsquez		TIME COMPLETED:	12:45 PM

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An unannounced Require Annual site inspection was conducted by Licensing Program Analyst (LPA), Bardo Baluyot, who met with Teacher, Monica Velasquez . This facility operates from 8am -12pm.

LPA observed 3 staff with 16 children. LPA found that facility is operating within ratio. Care and supervision was evaluated to determine if the basic needs of children are met. LPA observed during this inspection that facility is in compliance of this. LPA reviewed sign in/outs sheets. Children's roster was available for review.

Bungalow was identified and inspected. Furniture and equipment were inspected for age appropriateness and its condition. Telephone service, heating, lighting and ventilation were evaluated. Storage space/area for children's belongings was inspected. The condition and age appropriateness of children’s sinks and toilets were inspected. LPA evaluated general sanitation and cleanliness of facility. Availability of indoor drinking water was observed in form of water jug and disposable cups. Carbon Monoxide and Smoke detectors were tested and are functioning.

Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation area was inspected. A review of cleaning and food supply storage areas was made.

LPA inspected First Aid Kit supplies. Director's First Aid/CPR certification were reviewed and expire 6/26/2023.

Outdoor area and equipment was inspected for safety, cushioning material, condition and age appropriateness. Required shade and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. LPA observed no hazards. Outdoor drinking water is provided in form of a water jug and disposable cups.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: OPTIONS-STATE PRESCHOOL-EVERGREEN	FACILITY NUMBER: 198010785
	VISIT DATE: 09/21/2022

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

No deficiencies cited during today's visit in accordance with Title 22 California Code of Regulations.

No children and staff files were reviewed during today's visit. Files are kept in the Options State Preschool's main office located at: 18455 E. Railroad St. City of Industry, CA 91748 (626) 854-3449

Exit interview conducted and report was reviewed with Teacher, Monica Velasquez.

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

http://www.ccld.ca.gov – To access licensing forms, updates and Title 22 Regulations.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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