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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017671
Report Date: 01/18/2024
Date Signed: 01/18/2024 11:33:40 AM

Document Has Been Signed on 01/18/2024 11:33 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:OPTIONS - HEAD START/CDC - ARROYOFACILITY NUMBER:
198017671
ADMINISTRATOR:BELEN AMAVISCAFACILITY TYPE:
850
ADDRESS:836 WEST WOODBURY ROADTELEPHONE:
(626) 206-0733
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 35DATE:
01/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Arlene ChavezTIME COMPLETED:
11:40 AM
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On January 18, 2024, Licensing Program Analyst (LPA) Carolyn Tuba conducted a case management inspection due to an incident that occurred at the facility on 11/20/2023 in the outside play area (Play Structure). LPA met with staff, Arlene Chavez who contacted Education Supervisor, Lucy Ontiveros. LPA obtained the census of 35 children with 8 staff.


The incident was reported to the Department within the required 24 hours of occurrence. The incident consisted with a child having an injury that required medical attention.

LPA was unable to conduct interviews with staff who witnessed the incident, as they were unavailable, sue to one staff member was absent, and the other staff is a sub and is not assigned to the facility on a regular basis. LPA spoke with Education Supervisor over the phone, who stated that she will be forwarding the LPA the information for that staff member. However, LPA was able to interview Child #1 (C1) and took photos of the play structure where incident occurred. Staff member, Jennifer Castillo who works at the facility and is the site supervisor stated that a soft cushion material has been ordered and will be placed on the step where C1 bumped their forehead. After LPA interviewed C1, they disclosed that they were just playing by themselves and tripped, causing them to bump their head on the step of the structure. LPA reviewed the Unusual Incident Report (UIR) which stated that First Aid was provided to C1, and their parent was notified. Parent did seek medical attention and C1 has returned to school. UIR stated that staff will continue to speak with children about outside safety and continue to monitor and ensure safety.

No deficiencies were cited at this time.



A notice of site visit was given to staff member and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and a copy of this report was provided, along with appeal rights to staff, Arlene Chavez.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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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