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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407893
Report Date: 05/25/2022
Date Signed: 05/25/2022 11:52:12 AM


Document Has Been Signed on 05/25/2022 11:52 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:CHUNG FAMILY CHILD CAREFACILITY NUMBER:
197407893
ADMINISTRATOR:MAY LING CHUNGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
8186344829
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY:14CENSUS: 3DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:May Ling Chung, Licensee TIME COMPLETED:
11:55 AM
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On 5/25/2022 at 9:34 am Licensing Program Analyst (LPA), Denise Miranda conducted an unannounced Annual Required Inspection and was met by Licensee, May Ling Chung. This inspection was conducted in Spanish. Also present was Licensee’s father and one licensee's assistant.

Licensee provided an updated LIC279 Application form, LIC279B Current children were living in the house and LIC610A Emergency Disastwer for FCCH. Days and hours of operation are Monday – Friday from: 7:00AM to 7:00PM. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed.

During this inspection, it was observed that the licensee's home is a single story 4 bedroom, 3 bathroom home with living room, dining room, kitchen, attached garage.


The following areas are designated as follow and Licensee confirmed the: bedroom (for children), Living room, dining room, backyard and bathroom (for kids).
The off-limit : **Bedrooms #2,3 and #4, bathroom#2 and #3 and attached garage.

Body of water was observed: Jacuzzi is cover with a wood top and vase of plants was placed on the top. Per Licensee, she is not use the jacuzzi. The jacuzzi is make inaccessible to the children in care. LPA observed also, a fountain on the top of the wood cover of the jacuzzi, no water was observed inside of the fountain. LPA observed a tank with fish located by the jacuzzi. The tank with fish is cover with a wood and 2 vases with plants on the top of the tank with fish. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

Fireplace was observed on the living room, with screen. Per Licensee, the fire place is not in service. There is a working fire extinguisher, smoke detector, carbon monoxide detector

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CHUNG FAMILY CHILD CARE
FACILITY NUMBER: 197407893
VISIT DATE: 05/25/2022
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and adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed. Furniture was observed with no loose or sharp parts, clean and in good repair.
The home has working telephone service and LPA confirmed the phone number is (818) 634-4829.

There are currently 01 infants in care and 2 preschoolers. LPA discussed Safe Sleep Regulations with licensee.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats were not observed at facility. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed all required documents were placed in file. Licensee’s Mandated Reporter Training was completed on 5/19/2022 and her assistant and licensee’s assistant completed on 5/19/2022. Licensee’s pediatric CPR/First Aid issued on 12/16/2021 and will due for renewal on 12/23. There is currently 1 employee with CPR/First Aid issued on 12/16/2021.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CHUNG FAMILY CHILD CARE
FACILITY NUMBER: 197407893
VISIT DATE: 05/25/2022
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the

inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Staff interview conducted and documented at 11:10AM.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days. Page2

Exit interview conducted and report was reviewed with the Licensee. Report, Appeal Rights and Notice of Site Visit were given to Licensee May Ling Chung.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
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