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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191596482
Report Date: 04/04/2024
Date Signed: 04/04/2024 02:23:06 PM

Document Has Been Signed on 04/04/2024 02:23 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/
DIRECTOR:		ELAIEN ONFACILITY TYPE:
840
ADDRESS:400 CASUDA CANYON DRIVETELEPHONE:
(626) 576-0938
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 80TOTAL ENROLLED CHILDREN: 16CENSUS: 3DATE:
04/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Jeniffer Herrera, Education SupervisorTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
NARRATIVE
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On April 04, 2024, Licensing Program Analyst (LPA) Kruz Long conducted an unannounced case management visit. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Jeniffer Herrera, Education Supervisor and explained the purpose of the visit. LPA observed 3 children with 2 staff members.

The reason for the today’s visit is to provide findings for 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 the course of the investigation, LPA interviewed Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), Child #3 (C3) and Parent. LPA also obtained and viewed a copy of the recorded video of the incident between Child #1 (C1) and Child #2 (C2).

According to interviews with Staff members and C3, there was a physical altercation involving C1 and C2 on 01/04/24 in the structure located on the outdoor play yard. Interviews and records review revealed that multiple staff were present when C1 and C2 got into a physical altercation which was posted on social media and later taken down. It is unknown how or why staff was unaware of the incident. Though no children received medical attention, a lack of supervision occurred.

Based on interviews conducted, a review of video recording of the incident and a records review, the deficiency was cited in accordance with the Title 22 of the California Code of Regulations and Health & Safety Codes. Please see 809D for documentation of deficiency.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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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-MONTEREY HIGHLANDS
FACILITY NUMBER: 191596482
VISIT DATE: 04/04/2024
NARRATIVE
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Upon receipt of the licensing report. Licensee shall post report documenting Type A citation along with Notice of Site Visit Form in an area accessible for review for 30 days or a civil penalty of $100 will be assessed. Licensee shall also provide a copy of the report documenting Type A citation and any report resulting from a Non-Compliance Conference to all parents of currently enrolled children along with form LIC 9224 (Acknowledgement of Receipt of Licensing Report) for signature. Completed form shall be placed in child's file. Licensee shall also provide report and form to parents of newly enrolled children for the next 12 months.

An exit Interview was conducted, a copy of this report and appeal rights along with Notice of Site visit was provided to Jeniffer Herrera, Education Supervisor.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/04/2024 02:23 PM - It Cannot Be Edited


Created By: Kruz Long On 04/04/2024 at 02:00 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: OPTIONS-SURROUND CARE-MONTEREY HIGHLANDS
FACILITY NUMBER: 191596482

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/12/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified
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Licensee shall provide additional training (Section 101229 Responsibility for Providing Care and Supervision) to all staff who were present during time of incident and provide proof to the department by the POC date.
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in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidence by: According to interviews with Staff members and C3, there was a physical altercation involving C1 and C2 on 01/04/24 in the structure located on the outdoor play yard. Interviews and records review revealed that multiple staff were present when C1 and C2 got into a physical altercation which was posted on social media and later taken down. It is unknown how or why staff was unaware of incident. Though no children received medical attention, a lack of supervision occurred.
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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.
SUPERVISOR'S NAME:Ana Chico
LICENSING EVALUATOR NAME:Kruz Long
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024


LIC809 (FAS) - (06/04)
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