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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408128
Report Date: 05/07/2019
Date Signed: 05/07/2019 02:43:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CHIM-IN, PREEYAFACILITY NUMBER:
073408128
ADMINISTRATOR:CHIM-IN, PREEYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 926-5144
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:14CENSUS: 10DATE:
05/07/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Preeya Chim-InTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced case management site inspection for this facility for Plan of Correction follow up on 05/07/19 at 1355. LPA met with licensee Preeya Chim-In. Also present was assistant Phuong Tran and there were 10 napping children in care, consisting of three infants and seven preschool age children in care. LPA reviewed with licensee the plan of correction as submitted by licensee to LPA and LPA provided licensee with the proof of correction letter. LPA and licensee also reviewed the facility roster and the facility currently has a total of three infants enrolled in the facility. LPA also reviewed the facility's signed LIC 9224 forms and posting requirements.

There were no deficiencies cited during this inspection. A copy of the appeal rights was printed and provided and a notice of site visit was printed and is to remain posted for a period of 30 days. This report is to be available for review in the facility records for a period of three years.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019
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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