198016140-9-15-2022-33-CC-CGUA-CKEMKP-20221021094102

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198016140
Report Date: 09/15/2022
Date Signed: 09/15/2022 06:49:41 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/06/2022 and conducted by Evaluator Seung Lee

COMPLAINT CONTROL NUMBER: 33-CC-20220906123144

FACILITY NAME:	1.2.3. CHRISTIAN MISSION		FACILITY NUMBER:	198016140
ADMINISTRATOR:	JIN KYUNG LEE		FACILITY TYPE:	850
ADDRESS:	811 S. MANHATTAN PL.		TELEPHONE:	(213) 733-1123
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90005
CAPACITY:	45	CENSUS: 41	DATE:	09/15/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jin Kyung Lee		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility has inadequate record keeping for daycare children

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced complaint inspection. Upon arrival LPA Leet met with Director Jin Kyung Lee.

During the course of the investigation LPA Lee made observations, reviewed records, and conducted interviews in regards to the above allegation.

The complaint alleges that the facility is not requiring parents to submit a completed LIC 701 during the enrollment process and is concerned that the facility is not requiring immunization records for incoming children. The Director denied the allegations and made no disclosure. The Director stated that all parents are given a packet with blank forms that are required and the packet includes the LIC 701. The LIC 701 form is the physicians report for child care centers. During the inspection a file review for enrolled children was conducted by LPA Lee. During the records review for the 41 children present LPA Lee observed that child#1 was missing the LIC 701 and did not have the required immunization records that is part of the physicians report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Guangorena Claudia	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

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

LIC9099 (FAS) - (06/04)

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Control Number 33-CC-20220906123144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: 1.2.3. CHRISTIAN MISSION	FACILITY NUMBER: 198016140
	VISIT DATE: 09/15/2022

NARRATIVE

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When asked by LPA Lee why Child#1 did not have the required documents on file, The Director stated that she will check with the parent of Child#1 regarding the immunization records. Since only 1 out of 41 children did not have the required documents, it is not clear if the facility does not require immunization records during the enrollment process. However, the fact that Child#1 did not have the required documents present at the facility during the file review is a potential risk to the children in care.

Based on the information obtained during the investigation, the preponderance of evidence standard has been met, therefore the allegation that facility has inadequate record keeping for daycare children is substantiated. California Code of Regulations,(Title 22, Division 12 & Chapter Number 6), is being cited on the attached LIC 9099D.

The notice of site inspection must remain posted for a period of 30 days during hours of operation. Failure to maintain posting will result in a civil penalty of $100.00 dollars.

Exit interview conducted with Director Jin Kyung Lee. Appeal rights discussed and explained.

SUPERVISOR'S NAME: Guangorena Claudia	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 33-CC-20220906123144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: 1.2.3. CHRISTIAN MISSION	FACILITY NUMBER: 198016140
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/15/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/22/2022 Section Cited CCR 101220.1(a)	1 2 3 4 5 6 7	Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations. This requirement is not met evidenced by the fact that Child#1 did not have the required immunization on file at the facility at the time of today's inspection. This is a potential risk to children in care.	1 2 3 4 5 6 7	The Director stated that she will obtain the records from the parent of Child#1 by the POC date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Guangorena Claudia	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

LIC9099 (FAS) - (06/04)

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