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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500936
Report Date: 06/07/2022
Date Signed: 06/07/2022 12:18:42 PM

Document Has Been Signed on 06/07/2022 12:18 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-JELLICKFACILITY NUMBER:
191500936
ADMINISTRATOR:DEBORAH SLOBOJANFACILITY TYPE:
850
ADDRESS:1400 S. JELLICKTELEPHONE:
(626) 810-0163
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Lead Teacher, Ashley AlvarengaTIME COMPLETED:
12:30 PM
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An unannounced Required Annual inspection inspection was conducted today by Licensing Program Analyst (LPA), Bardo Baluyot, who met with Lead Teacher, Ashley Alvarenga and Assistant Teacher, Julie Luna. LPA conducted a Covid risk self-assessment upon entering. Per Ms. Alvarenga, State Pre School under the same facility number ended their year on 5/24 and they operate as a PM Head Start Program. Head Start Program operates 12:15 PM to 5:15 PM. LPA conducted a complete tour of the facility. No children were present upon arrival.

Rooms identified on facility sketch were inspected Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with a sink, toilet were inspected. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed.

Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water.

Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness. A review of cleaning and food supply storage areas was made. Per Ms. Alvarenga, facility provides lunch and PM Snack.

First Aid supplies were inventoried and were found to be adequate.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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-JELLICK
FACILITY NUMBER: 191500936
VISIT DATE: 06/07/2022
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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


Teacher child ratios were discussed and staff names recorded. Proper Care and supervision was evaluated to determine if the basic needs of children are met.

Main staff and children's files are stored at the Options State Preschool's main office, located at: 18455 E. Railroad St. City of Industry, CA 91748. Tel # (626) 854-3449

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

After a complete inspection of the facility, no deficiencies were observed in accordance with the California Code of Regulations Title 22 Division 12.

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.

Exit interview conducted and report was reviewed with the Lead Teacher, Ashley Alvarenga.


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: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC809 (FAS) - (06/04)
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