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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593096
Report Date: 10/29/2025
Date Signed: 10/29/2025 03:17:58 PM

Document Has Been Signed on 10/29/2025 03:17 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-SHELYNFACILITY NUMBER:
191593096
ADMINISTRATOR/
DIRECTOR:		PATTY CHENFACILITY TYPE:
840
ADDRESS:19500 E. NACORA STTELEPHONE:
(909) 594-2075
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 3DATE:
10/29/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Hameeda Ahmed - TeacherTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection. This inspection is a subsequent visit for a Case Management conducted on 09/23/2025. Upon arrival at 1:50pm, LPA met with Teacher Hameeda Ahmed, to whom the purpose of the inspection was explained. Education Supervisor Tina Jaspe arrived at 2:10pm. A tour of the facility was conducted. There were 3 children with 2 staff member during the tour.

On 09/10/2025, Child #1 disclosed to Staff #1 that Staff #3 had hit them on the head and pulled their ears. Initial inspection of this incident took was conducted on 09/23/2025. During the follow up to this incident, LPA conducted interviews with three staff members, three children, and had phone conversations with two Detectives.

During interviews, Child #1 (C1) disclosed that Staff #3 (S3) had hit them on the head while C1 was reading a book to the class. They stated that their ears were pulled by S3 by the table area. Per C1, they were not able to think of any reason for it happening. Child #2 (C2) stated that they also have been hit on the head by S3. For the incident with C1, they shared that, "We were reading a book and just talking and chattered, and S3 hit C1 on the head." Child #3 (C3) also corroborated the incident on the carpet during story time. C3 explained that, "C1 knew that was wrong and said 'Hey you cant do that' but S3 said 'I was just playing.'' There was no disclosed observations of C1's ears being pulled.

Per interview with S3, they stated that children were playing around with new pillows in the carpet area and hitting each other with them. S3 joined in the "pillow fight." S3 stated "There were a lot of pillows and a new couch. I walked over to talk to them and I told them don't do that with the pillow and to stop doing with the pillows. We stopped and then we put the pillows away." Interview with S3 discloses that there was a form of physical contact made between staff and child.


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: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2025
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)
Page: 2 of 4
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-SHELYN
FACILITY NUMBER: 191593096
VISIT DATE: 10/29/2025
NARRATIVE
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Options For Learning conducted a report to the local sheriff's department. Detectives from Walnut Sheriff Department conducted interviews with the children involved in the incident as well as staff. Staff #1 states that parent of C1 has been spoken to and that they are not pressing charges. Per Staff #1, C1 has left the program with the parent stating "At the end of the day, S3 placed their hand on a child." Since the incident, Staff #3 has been placed on Administrative Leave, pending investigation.

LPA spoke with Detectives that responded to the incident and interviewed the children involved. According to the Detectives, C1 confirmed the incident with S3. Police report is currently in process of being obtained from the Walnut Sheriff's Department.

Based on the information above, it was determined that Staff #3 did physically contact Child #1 while in care, violating their personal rights. There were witnesses who corroborated the incident where Staff #3 hit Child #1 in the carpet area. Interviews did not disclose any immediate risk to Child #1 during the incident. Facility followed through with protocol in response to incident.

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 Education Supervisor Tina Jaspe, at 3:15pm. 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: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/06/2025 02:36 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 11/04/2025 09:50 AM


Created By: Nolan Tcheng On 10/29/2025 at 02:47 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: OPTIONS-SURROUND CARE-SHELYN
FACILITY NUMBER: 191593096

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2025
Section Cited
CCR
101223(a)(1)

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Personal Rights
(1) To be accorded dignity in his/her personal relationships with staff and other persons.


This requirement is not met as evidenced by:
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Per Education Supervisor, they will conduct a training going over Children's Personal Rights. They will created a training agenda and have staff sign an attendance showing acknowledgement. Will be sent to LPA by POC
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Based on interview, Licensee did not ensure that Child #1 was accorded dignity in their relationship with Staff #3, as Staff #3 hit Child #1 on the head while in care. This posed a potential risk to the health, safety, and personal rights of children in care.
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AMNENDED: This report is being amended to change the numbered identifier indicating the correct staff involved in the incident.

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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: 10/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2025


LIC809 (FAS) - (06/04)
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