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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003377
Report Date: 11/05/2025
Date Signed: 11/05/2025 03:47:54 PM

Document Has Been Signed on 11/05/2025 03:47 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: 22DATE:
11/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Claudia Arias - Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection to follow up on an incident reported to the Department on 10/27/2025. Upon arrival at 2:10pm, LPA met with Lead Teacher Claudia Arias, to whom the purpose of the inspection was explained. Also present was Education Supervisor Amber Cervantes. A tour of the facility was provided and census was taken. There were 22 children with 4 staff members.

On 10/24/2025, an incident occurred where Child #1 had an outburst and began throwing things around the classroom. During the outburst, an item was thrown and hit another child in care. Staff present escorted children out of the classroom to further remove them from potential dangers, while another staff stayed with Child #1 till they were able to calm down. LPA conducted two interviews during today's inspection and had Staff #1 send email statements to LPA. During interview, Staff #1 stated that Child #1 does have an IEP and has had a history of outbursts similar to the one that occurred on 10/24/2025. The child often screams, cries, and throws things around them, using their body during their "big feelings." Staff #1 states that the outbursts happen during transition or when they hear certain words that trigger it. There was a Behavioral Specialist present to assist with Child #1. Specialist currently attends part time during the week.

During today's inspection, Child #1 did have a brief outburst during transition time. Child #1 did scream before starting to throw items around the room. Staff present were able to start escorting the other children from the classroom while Education Supervisor Amber Cervantes assisted with redirecting and calming child down. Child was able to regulate, clean up from their previous activity, and rejoin the group for snack time.Per Staff #1, there have been recorded incidents that have occurred previously and discussions with parent has taken place.

REPORT CONTINUES PAGE 1 of 2

NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Nolan Tcheng
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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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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: 11/05/2025
NARRATIVE
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Based on the information obtained, the incident with Child #1 violated the Personal Rights of other children enrolled. Child #1 has had a history of outbursts while in care and the incident on 10/24/2025 resulted in another child in care getting hurt and needing first aid. Staff followed through with appropriate responses with the children in care, having them moved to another area, away from the outburst.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Lead Teacher Claudia Arias, at 3:40pm. Copy of Report provided.

END OF REPORT PAGE 2 of 2

NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Nolan Tcheng
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/05/2025 03:47 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 11/05/2025 at 03:21 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: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2025
Section Cited
CCR
101223(a)(1)

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Personal Rights
(1) To be accorded dignity in his/her personal relationships with staff and other persons.


This requirement is not met as evidenced by:
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Per Lead Teacher, Options For Learning witll create a Behavior Contract for CHild #1 that will be reviewed and signed by their parent. Contract will entail requirements for parent to pick up Child #1 during outbursts, and potential termination if child is not deemed safe for the program, staff, and other
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Based on interview and observation Licensee did not ensure that children in care are accorded digity in relationship with Child #1, who has a history of outbursts, who threw an item, and hitting another child. This was a potential risk to the health, safety and personal rights of children in care
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children in care. Assistance being provided should also be explained in contract. Signed copy will be submitted to LPA by POC date.

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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.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Nolan Tcheng
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2025


LIC809 (FAS) - (06/04)
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