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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003377
Report Date: 09/20/2024
Date Signed: 09/20/2024 01:56:05 PM

Document Has Been Signed on 09/20/2024 01:56 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: 9CENSUS: 1DATE:
09/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Claudia Arias, Site Director/TeacherTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
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On 09/20/2024, Licensing Program Analyst (LPA) Kruz Long conducted an unannounced case management visit. A COVID-19 risk assessment was conducted. LPA met with Claudia Arias, Site Director/Teacher and explained the purpose of the visit. LPA observed 1 child with 1 staff member.

The purpose for today’s visit is to deliver investigation finding for 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.

During the course of the investigation, LPA interviewed Staff #1 (S1), Staff #2 (S2) and Staff #3 (S3), Child #2 (C2), Child #3 (C3) and attempted to interview Child #1 (C1).

According to interviews conducted with staff, there was a field trip that took place on 07/22/24 to the Long Beach Aquarium. Children were broken up into smaller groups with a ratio of 3-5 children to 1 staff. All staff, which included lead teachers and assistants, remained inside the aquarium as they toured the exhibits with the children in separate groups. According to S1, all staff and groups were to meet for lunch. Per S1, the group containing C1 did not arrive at the meeting location for lunch. For about 15 minutes. S1 attempted to contact S2 who was supervising the group that did not arrive at the meeting location. S1 called S3 to inform that S2’s group did not arrive at the meeting location for lunch. S1 then found the missing group, however, C1 was missing. S1 assisted S2 in locating C1 who was found at the gift shop.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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-WASHINGTON
FACILITY NUMBER: 198003377
VISIT DATE: 09/20/2024
NARRATIVE
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Per S2, the group was in the seal habitat exhibit and proceeded to go down the stairs for lunch. C1 wanted to circle around to meet the group instead of following the group. The circle did not meet at the same place. According to S2, they observed C1 walk away from the group and was unable to catch up to C1. The groups were gathered and while other Staff members supervised the children, S1 went to find C1. C1 was gone for about 5 minutes. S1 then found C1. Per S3, S3 was roaming the aquarium and found S2. S2 informed S3 that C1 was missing for about 4 minutes. S3 later received a call from S1 indicating C1 had been found. Per C3, C1 got lost but did not disclose how.

Based on interviews conducted, the deficiency was cited in accordance with the Title 22 of the California Code of Regulations and Health & Safety Codes. Please see LIC809D for documentation of deficiency.

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 Site Director.

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

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/20/2024 01:56 PM - It Cannot Be Edited


Created By: Kruz Long On 09/20/2024 at 01:32 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-WASHINGTON
FACILITY NUMBER: 198003377

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2024
Section Cited
CCR
101229(a)(1)

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101229(a)(1)
Responsibility for Providing Care and Supervision
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
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Licensee shall provide additional training (Section 101229 Responsibility for Providing Care and Supervision) to staff that is assigned to this facility during time of incident and provide proof to the department by the POC date.
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teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidence by:
Based on interviews, C1 was missing for a period of time during a field trip.
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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: 09/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2024


LIC809 (FAS) - (06/04)
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