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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000580
Report Date: 02/22/2024
Date Signed: 02/22/2024 02:20:54 PM

Document Has Been Signed on 02/22/2024 02:20 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 STATE HEADSTART -WALNUT/DIAMOND/HOLLINGWORFACILITY NUMBER:
198000580
ADMINISTRATOR:DEBORAH SLOBOJANFACILITY TYPE:
850
ADDRESS:3005 EAST HOLLINGWORTH STREETTELEPHONE:
(909) 594-8509
CITY:WEST COVINASTATE: CAZIP CODE:
91792
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
02/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Alicia Rangel, TeacherTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Kruz Long a conducted a subsequent unannounced case management visit on 02/22/24. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Alicia Rangel, Teacher and explained the purpose of the visit. LPA observed 13 children with 3 staff members.

The purpose of the visit is to follow up on an incident that occurred on 12/01/23 and was reported to the department on 12/04/23 (reported timely). The self reported incident is regarding personal rights.

During the investigation, LPA interviewed Family member, Staff #1 (S1) and Staff #2 (S2) and Child #1 (C1) to Child #5 (C5).

Based on interviews with S1 and S2 and C2 to C5, there were no corroborating information to determine that a personal rights violation occurred. The facility is not being cited any deficiencies today.

An exit interview was conducted and a copy of this report was provided to Alicia Rangel, Teacher. 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: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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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