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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014553
Report Date: 11/21/2022
Date Signed: 11/21/2022 04:56:29 PM

Document Has Been Signed on 11/21/2022 04:56 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 CDC - ROOSEVELTFACILITY NUMBER:
198014553
ADMINISTRATOR:ROCIO ARROYOFACILITY TYPE:
850
ADDRESS:5356 DELTA AVENUETELEPHONE:
(626) 858-0527
CITY:SAN GABRIELSTATE: CAZIP CODE:
91776
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 25DATE:
11/21/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
03:33 PM
MET WITH:Site Director, Paula GomezTIME COMPLETED:
05:00 PM
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At approximately 2 PM, LPA Baluyot conducted a Case Management Annual Continuation for the purpose of reviewing children and staff files at Options Full Day program's main office. LPA met with Division Director, Denise McCullough who facilitated file review.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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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