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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014453
Report Date: 04/01/2026
Date Signed: 04/01/2026 03:08:56 PM

Document Has Been Signed on 04/01/2026 03:08 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-MEADOW GREENFACILITY NUMBER:
198014453
ADMINISTRATOR/
DIRECTOR:		MILDRED BALDERRAMAFACILITY TYPE:
840
ADDRESS:12025 GROVEDALETELEPHONE:
(562) 902-0300
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 1DATE:
04/01/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Jacqueline Carras - Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
03:35 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 03/19/2026. Upon arrival at 1:50pm, LPA met with Facility Representative Jacqueline Carras, to whom the purpose of the inspection was explained. A tour was conducted and census was taken. There was 1 child and 2 staff members during the time of tour.

On 03/13/2026, Staff #1 was caring for 16 children outside of the portable classroom, due to it being locked. The Substitute teacher that was assigned to the facility for that day had not come. Interview was conducted with 1 staff member.

Per Staff #1 (S1), they arrived at 2pm to a locked classroom. They received a kindergarten pick up and was outside with them for about 1 hour. They had immediately contacted Options For Learning in order to find out who would come to assist and when they would be arriving. By 3pm, S1 was there during the older children school release. Per S1, they were alone with 16 children that day, as attendance was kept with their phone. S1 also stated that it was hot that day so they were using water fountains and trying to stay cool. At 3:45pm, the floater teacher had arrived to help, and had informed S1 that there was a miscommunication from supervisors and they had been told they did not need to report to Meadow Green, and had been sent elsewhere to report.

Based on the information above, the facility was in Violation of Teacher-Child Ratio. S1 was in care of 16 children at one time and was not able to be granted access to the classroom for 1hr and 45 minutes. They supervised the children, provided care, and used the school office as needed when it came to first aid. Parents were notified of what had happened during pick up. S1 did everything they could to ensure a safe environment that day. There was no immediate risk to the children in care. They will be cited in accordance with California Title 22 regulations. 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: 04/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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-MEADOW GREEN
FACILITY NUMBER: 198014453
VISIT DATE: 04/01/2026
NARRATIVE
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The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

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

Exit interview conducted and report was reviewed with Facility Representative Jacqueline Carras, at 3:20pm. Copy of Report provided.

END OF REPORT PAGE 3 of 3

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

DATE: 04/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/01/2026 03:08 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 04/01/2026 at 02:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: OPTIONS SURROUND CARE-MEADOW GREEN
FACILITY NUMBER: 198014453

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2026
Section Cited
CCR
101516.5(b)

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Teacher-Child Ratio
b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance.

This requirement was not met as evidenced by:
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Per Facility Representative, Options For Learning will provide a step by step plan for sustitute teacher policy when a someone is filling in for a new site. A form that will provide immediate contact information an schedule information for the sub that day. This will be provided to the all facility staff
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Based on interview and record review, Licensee did not ensure that Staff #1 had additional staff present, to be considered in ratio for 16 children, on 03/13/2026. This was a potential risk to the health, safety, and personal rights of children in care.
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PRIOR to the day the substitute comes, as well as given to the subtitute so they can contact facility if behind schedule, running late, sick, etc. A copy of the template will be sent to LPA by POC date.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Nolan Tcheng
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/01/2026


LIC809 (FAS) - (06/04)
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