198019610-9-26-2024-33-CC-POCA-D9GS7G-20240926133731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019610
Report Date: 09/26/2024
Date Signed: 09/26/2024 01:37:35 PM

Document Has Been Signed on 09/26/2024 01:37 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 STATE HEAD START FULL DAY		FACILITY NUMBER:	198019610
ADMINISTRATOR/ DIRECTOR:	DEBORAH SLOBOJAN		FACILITY TYPE:	850
ADDRESS:	203 S. AZUSA AVE		TELEPHONE:	(626) 858-0527
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91790
CAPACITY: 140	TOTAL ENROLLED CHILDREN: 140	CENSUS: 50	DATE:	09/26/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Site Supervisor, Cecilia Noriega		TIME VISIT/ INSPECTION COMPLETED:	01:40 PM

NARRATIVE

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On September 26, 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, Cecilia Noriega. The purpose of this inspection is to follow up on a self-reported incident that occurred at the facility on 06/28/2024 before the facility closed for summer break.

Brief summary of incident: Child #1 (C1) was running on the outside playground and bumped into Child #2 (C2). C1 tripped and fell. C1’s face and glasses hit the ground causing a cut to the middle of the forehead.

In course of the investigation, LPA interviewed Staff #1 (S1), Staff #2 (S2), Staff 3 (S3). LPA attempted to interview C1 and C2 , but C1 and C2 are no longer in the program.

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, Cecilia Noriega.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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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