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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017688
Report Date: 11/21/2022
Date Signed: 11/21/2022 04:53:59 PM

Document Has Been Signed on 11/21/2022 04:53 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-HEAD START/CDC-ORANGE GROVEFACILITY NUMBER:
198017688
ADMINISTRATOR:EVANGELINA PADILLAFACILITY TYPE:
850
ADDRESS:595 N. LINCOLN AVENUETELEPHONE:
(626) 206-0730
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 12DATE:
11/21/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Site Director, Alma CamposTIME 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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