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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191596482
Report Date: 03/26/2024
Date Signed: 03/26/2024 01:52:23 PM

Document Has Been Signed on 03/26/2024 01:52 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-MONTEREY HIGHLANDSFACILITY NUMBER:
191596482
ADMINISTRATOR:ELAIEN ONFACILITY TYPE:
840
ADDRESS:400 CASUDA CANYON DRIVETELEPHONE:
(626) 576-0938
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 80TOTAL ENROLLED CHILDREN: 162CENSUS: 22DATE:
03/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Nancy Romero, Site DirectorTIME COMPLETED:
02:00 PM
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On March 26, 2024, Licensing Program Analyst (LPA) Kruz Long conducted an unannounced case management inspection. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Nancy Romero, Site Director and explained the purpose of the visit. LPA observed 22 children with 5 staff members.

The purpose of the visit is to follow up on an incident that occurred on 01/04/2024 and was reported to the department on 03/04/2024. The self reported incident is regarding supervision/personal rights.

During this inspection, LPA interviewed Child #3 (C3).

There are no deficiencies being cited today, as the incident requires further investigation.

An exit interview was conducted and a copy of this report was provided to Nancy Romero, Site Director. A Notice of Site Visit was provided; Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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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