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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003377
Report Date: 09/18/2024
Date Signed: 09/18/2024 02:07:44 PM

Document Has Been Signed on 09/18/2024 02:07 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-WASHINGTONFACILITY NUMBER:
198003377
ADMINISTRATOR/
DIRECTOR:		DARLA VILLARUELFACILITY TYPE:
840
ADDRESS:300 N. SAN MARINOTELEPHONE:
(818) 282-1223
CITY:SAN GABRIELSTATE: CAZIP CODE:
91775
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 8DATE:
09/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH: Amber Cervantes, Education Supervisor TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 09/18/2024, 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 Amber Cervantes, Education Supervisor and explained the purpose of the visit. LPA observed 8 children with 2 staff members.

The purpose for the today’s visit is to deliver investigation findings on an incident that occurred on 07/22/2024. The incident was self-reported to the department on 07/31/2024. The incident is regarding supervision.

Due to technical difficulties, LPA will returned at a later time to deliver investigation findings.

An exit Interview was conducted, a copy of this report and Notice of Site visit was provided to The Education Supervisor.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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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