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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006952
Report Date: 10/15/2025
Date Signed: 10/15/2025 03:21:28 PM

Document Has Been Signed on 10/15/2025 03:21 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-RORIMERFACILITY NUMBER:
198006952
ADMINISTRATOR/
DIRECTOR:		SYLVIA ARTEAFACILITY TYPE:
840
ADDRESS:18750 E. RORIMERTELEPHONE:
(626) 810-7509
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 0DATE:
10/15/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Jasmine Wallace - Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
03:40 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 10/02/2025. Upon arrival at 1:10pm, LPA met with Lead Teacher Jasmine Wallace, to whom the purpose of the inspection was explained. A tour of the facility was provided. There were 0 children and 4 staff members present during time of tour.

On 09/30/2025, Child #1 had a behavioral episode and began to scream and throw items around the room. Child #1 then eloped from the classroom/bungalow and ran to the side gate of the preschool building and hopped the small fence (locked with padlock). Child then climbed a taller gate behind the small gate that separated the elementary school and the facility licensed area. Staff ran through other gates nearby to cut off child by the elementary school playground field area. The chase continued further into the school cafeteria but child was eventually able to sit at a table to self-regulate before rejoining. School district police were called to the site and assisted staff in bringing child to classroom to calm down.

There was another incident that occurred on 10/08/2025 where Child #1 had another episode due to another child making them upset. Child was thrashing and throwing items around the classroom again. The rest of the class was moved to the outdoor play area immediately when the episode began. Child eloped from classroom and climbed the same small gate by the preschool classroom and attempted to climb the elementary school gate but was stopped before they could. Child tried to harm teachers with their body and a large stick. LPA observed videos of the child acting as described, including attempting to harm staff. Staff were observed to be trying to de-escalate the situation in the video.

Child #1 was suspended following the first incident for 10/01/2025-10/02/2025. And following the next incident on 10/08/2025, the child's parent established they would be picking up Child #1 directly from school. Child #1 will attend facility when family has no other means of care. During today's inspection, Child #1 did attend for care. 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: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2025
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-RORIMER
FACILITY NUMBER: 198006952
VISIT DATE: 10/15/2025
NARRATIVE
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LPA discussed with staff the steps they have taken since the incidents took place. They stated that that as soon as Child #1 starts acting out that the parent will be contacted and Child #1 is required to be picked up immediately. Children will be moved to another area to allow Child #1 space, and to keep other children in care from harm. There will be one teacher that stays with Child #1 to make sure no harm is done and to try and de-escalate. If possible, they will have another teacher there to help keep child from eloping at any exits. Facility has all counselor and teacher numbers for the elementary school if they need assistance and they have the contact for the school district patrol. The process has started to have the child assessed through their inclusion and wellness branch and then to be assessed with Five Acres (behavioral health services). A behavior contract is being created for Child #1 and their family.

LPA interviewed two staff members during today's inspection and obtained documents in the form of facility incident reports and Initial Concerns Form. Video was reviewed during today's inspection.

Based on the information obtained during today's inspection, facility staff did all appropriate actions to try to de-escalate Child #1's behavior and to keep other children in care safe from harm. LPA is providing an Advisory Note -Technical Assistance to address a Plan of Supervision for Child #1 and to advise having the authorized representative be included in the understanding of the Plan of Supervision.

Facility is being cited for Reporting Requirements. The initial incident on 09/30/2025 was not reported to the Department until 10/02/2025, exceeding the required 24 hrs, per Title 22. The incident that took place on 10/08/2025, affected children in care and was not reported to the Department.

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 Education Supervisor Darla Villarruel, at 3:20pm. Plan of corrections was developed and 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: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/15/2025 03:21 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 10/15/2025 at 02:43 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-RORIMER
FACILITY NUMBER: 198006952

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/22/2025
Section Cited
CCR
101212(d)(1)(C)

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Reporting Requirements
(d) Upon the occurrence...a report shall be made to the Department ...within the Department's next working day (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
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Per Lead Teacher, they will submit an unusual incident report to the Department by POC date for the incident that took place on 10/08/25. A statement from staff and administration will be submitted stating they will immediately report a UIR that concerns Child #1.
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This requirement is not met as evidenced by:
Based on record review and interview, the licensee did not ensure that an incident on 09/30/25 was reported within 24 hrs, and an incident on 10/08/25, was not reported. This poses a potential risk to the health, safety, and personal rights of children in care.
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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: 10/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2025


LIC809 (FAS) - (06/04)
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