198009114-1-9-2023-54-CC-MAYA-CMX2VY-20230109164444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198009114
Report Date: 01/09/2023
Date Signed: 01/09/2023 04:45:05 PM

Document Has Been Signed on 01/09/2023 04:45 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	CPC PRESCHOOL		FACILITY NUMBER:	198009114
ADMINISTRATOR:	KIM SUNG MEE		FACILITY TYPE:	850
ADDRESS:	11840 E. 178TH ST.		TELEPHONE:	(562) 246-0360
CITY:	ARTESIA	STATE: CA	ZIP CODE:	90701
CAPACITY:	90	CENSUS: 56	DATE:	01/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Director, Kim Sung Mee		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On January 9, 2023 at 2:00 pm, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Kim Sung Mee. The purpose of the inspection was to conduct the Required 1 Year inspection at the facility. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Director upon arrival. The facility is located on the premises of Cerritos Presbyterian Church. Per Director, the program operates Monday through Friday from 7:00 am to 6:00 pm. The Director guided LPA on a tour of the inside and outside of the facility. All areas on the facility sketch were inspected. The facility currently utilizes 9 classrooms; 101, 102, 103, 105, 106, 107, 108, 109, and 110. Upon arrival, the following staff were present: Staff (S1) inside Room 101 with 15 napping children, S2 inside Room 105 with 16 napping children, S3 inside Room 106 with 5 napping children, S4 inside Room 107 with 10 napping children, and S5 inside Room 109 with 10 napping children. The following documents are posted in a prominent, publicly accessible area: Facility License, Menu, Child Passenger Restraint System Poster (PUB 269), Notification of Parents' Rights (LIC 393), Emergency Disaster Plan (LIC 610), Personal Rights (LIC 613A), Earthquake Preparedness (LIC 9148), Waiver and Daily Activity Schedule. Children's roster was reviewed and is current. Sign-in and sign-out sheets were reviewed; all children present were signed in. Per Director, transportation is not provided by the program. Per Director, bedding is taken home on a weekly basis to be washed. According to the Director, medication is only administered to a child when accompanied with a doctor's note and medication is stored in a cabinet located in the office.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CPC PRESCHOOL	FACILITY NUMBER: 198009114
	VISIT DATE: 01/09/2023

NARRATIVE

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Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. LPA observed napping equipment (cots) and cubbies inside each classroom. Per Director, the isolation area is in the office. In the office, a cot can be placed on the floor for an ill child and the staff restroom is readily available if an ill child requires it. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor and outdoor drinking water was observed (water jugs and disposable cups).

Carbon monoxide detector and smoke detector were not tested during today's inspection due to being wired to the emergency pull down system. The fire extinguishers are fully charged and were last serviced on June 2, 2022. LPA observed electrical outlet covers installed in all child care areas. First Aid supplies were observed and kept inside the office. Per Director, the facility has not conducted any fire and/or disaster drills due to the COVID-19 pandemic. The last documented drill was conducted on September 22, 2018.

Disinfectants, cleaning solutions, and other items that are hazardous to children, were made inaccessible to children in all areas. Director confirmed that there are no poisons stored at the facility. All kitchen, food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair. Food and snacks were reviewed for availability, quantity and appropriateness to children in care.

Outdoor playground equipment is in a safe condition, free of sharp, lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that could absorb a fall. LPA observed adequate shade in the outdoor play yard. The facility has an indoor gymnasium used for play when the weather does not permit for outdoor play. LPA inspected the gymnasium for hazards. No bodies of water was observed on the premises.

All individuals present have obtained a criminal record clearance or criminal record exemption. Director was reminded that all adults 18 and over, 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 Child Care Center. 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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC809 (FAS) - (06/04)

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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CPC PRESCHOOL	FACILITY NUMBER: 198009114
	VISIT DATE: 01/09/2023

NARRATIVE

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LPA conducted a review of 6 children’s records and 6 personnel records for completeness. Based on the record reviews, all of the 6 children's records were missing the Admission Agreement. Child (C6) also did not have the Physician's Report (LIC 701) available for review. The facility did not have the Mandated Reporter (AB 1207) available for review for all staff present. Staff (S2) did not have the Health Screening Report (LIC 503) available for review. Staff (S3) did not have the immunization record for measles, pertussis, and influenza, or documentation of exemption available for review. Staff (S4) did not have verification of staff qualifications (transcripts or teacher permit) available for review. LPA also found that the Director, Sung Mee Kim did not have a certificate of completion for Preventative Health and Safety Practices (EMSA-approved) available for review. During the inspection, there was at least one staff present with a valid Pediatric First Aid and CPR certification. The names of children and staff whose records were reviewed were documented.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA advised the Director on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at: www.ccld.ca.gov.

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.

Deficiencies were cited during today's inspection (refer to deficiency pages). A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Director, Sung Mee Kim.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/09/2023 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CPC PRESCHOOL	FACILITY NUMBER: 198009114
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 6 personnel records (S3) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2023
	Plan of Correction
1 2 3 4	Director will submit the immunization record (measles, pertussis, and influenza, or documentation of exemption) for Staff (S3) to LPA via e-mail by February 9, 2023.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 6 out of 6 personnel records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2023
	Plan of Correction
1 2 3 4	Director will submit proof of completion for the Mandated Reporter (AB 1207) training for the Director, S1, S2, S3, S4, and S5 to LPA via e-mail by February 9, 2023.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/09/2023 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CPC PRESCHOOL	FACILITY NUMBER: 198009114
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101215.1(m)

Child Care Center Director Qualifications and Duties

(m) A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the Director did not have a certificate of completion for the Preventative Health and Safety Practices (EMSA-approved) available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2023
	Plan of Correction
1 2 3 4	Director will submit proof of completion for the Preventative Health and Safety Practices (EMSA-approved) training to LPA via e-mail by February 9, 2023.

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 6 personnel records (S2) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2023
	Plan of Correction
1 2 3 4	Director will submit the completed Health Screening Report (LIC 503) for Staff (S2) to LPA via e-mail by February 9, 2023.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/09/2023 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CPC PRESCHOOL	FACILITY NUMBER: 198009114
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216.1(g)

Teacher Qualifications and Duties

(g) A photocopy of the teacher's Child Development Permit as specified in (c)(3) above, or a photocopy of the teacher's transcript(s) documenting successful completion of required course work, shall be maintained at the center. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 6 personnel records (S4) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2023
	Plan of Correction
1 2 3 4	Director will submit a copy of the staff qualifications (Teacher's Child Developmental Permit or transcripts) for Staff (S4) to LPA via e-mail by February 9, 2023.

Type B

Section Cited

CCR

101220(a)

Child's Medical Assessments

(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 6 children's records (C6) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2023
	Plan of Correction
1 2 3 4	Director will submit the completed Physician's Report (LIC 701) for child (C6) to LPA via e-mail by February 9, 2023.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/09/2023 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CPC PRESCHOOL	FACILITY NUMBER: 198009114
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101221(b)(6)

Child's Records

(b) Each record shall contain information including, but not limited to, the following: (6) A signed copy of the admission agreement specified in Section 101219. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 6 out of 6 children's records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2023
	Plan of Correction
1 2 3 4	Director will submit the signed copy of the Admission Agreement for child (C1-C6) to LPA via e-mail by February 9, 2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC809 (FAS) - (06/04)

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