191597150-1-21-2026-33-CC-NTCG-DQJW25-20260121155347

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191597150
Report Date: 01/21/2026
Date Signed: 01/21/2026 03:53:50 PM

Document Has Been Signed on 01/21/2026 03:53 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-JELLICK		FACILITY NUMBER:	191597150
ADMINISTRATOR/ DIRECTOR:	DARLEEN JUAREZ		FACILITY TYPE:	840
ADDRESS:	1400 S. JELLICK AVE		TELEPHONE:	(626) 912-1776
CITY:	ROWLAND HEIGHTS	STATE: CA	ZIP CODE:	91748
CAPACITY: 80	TOTAL ENROLLED CHILDREN: 80	CENSUS: 19	DATE:	01/21/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:20 PM
MET WITH:	Margaret Romo - Lead Teacher		TIME VISIT/ INSPECTION COMPLETED:	04:05 PM

NARRATIVE

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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection for the purpose of following up on an incident reported to the Department on 12/09/2025. Upon arrival at 2:20pm, LPA met with Facility Representative Margaret Romo, to whom the purpose of the inspection was explained. A tour of the facility was conducted between the two (2) classrooms/bungalows. There were 19 children with 5 staff members.

On 12/08/2025, Child #1 was observed by Staff #3 walking back to their classroom from the restrooms after their class had already gone inside. Child was described as being separated from their group. During today's inspection, LPA conducted interviews with 2 staff members. Staff #1 (S1) explained that they were leading their group to the classroom from the restrooms and had Staff #2 stand at door to finish transition head count while S1 moved inside with the children. Staff #2 miscounted and closed the door on Child #1, who was walking slower towards the classroom than the rest of the group. A minute or two later, after the group had sat down at the snack tables, Child #1 opened the door and was came in. Parents were contacted and informed, and incident was reported to Department. Per S1, Staff #3 was outside and Child #1 was visually observed the whole way back to their classroom. Staff #2 is no longer with the agency, and was not interviewed. Staff #3 was contacted and confirmed that they were by the storage bins and was able to observed Child #1 returning back to their classroom.

Based on information above, LPA determined there was not a lack of supervision during the incident on 12/08/2025, since Staff #3 was able to observe Child #1 walking back to their classroom. No deficiencies are being cited during today's inspection. A Technical Assistance is being provided to recommended better supervision practices during transition. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility Representative Margaret Romo, at 3:50pm. Copy of report provided. END OF REPORT

NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Nolan Tcheng
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

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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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)

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