198016640-8-26-2022-33-CC-SLEE-CHNTX3-20220826150629

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016640
Report Date: 08/26/2022
Date Signed: 08/26/2022 06:17:21 PM

Document Has Been Signed on 08/26/2022 06:17 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KIM FAMILY CHILD CARE		FACILITY NUMBER:	198016640
ADMINISTRATOR:	KIM, YOUNG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 389-5015
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90006
CAPACITY:	14	CENSUS: 2	DATE:	08/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Young Kim		TIME COMPLETED:	03:30 PM

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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced annual random site visit to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPA met with Licensee, Young Kim and toured the facility. There were 2 children present. Individuals residing in the home are the licensee, licensee's spouse, and licensee's two adult children. Licensee’s operating hours are Monday-Friday 6am-6pm.

This is a two story home consisting of 4 bedrooms and 3 bathrooms. The following areas are used for day-care: Living Room, 1 bedroom, 1 restroom, and parts of the back yard. Off limit areas include: All of upstairs, 3 bedrooms, 2 bathrooms, kitchen/dining area, and parts of the back yard.

Licensee has the Parent’s Rights poster and other appropriate forms posted on wall in the living room. First Aid/CPR certificate are valid thru 02/2024. Licensee stated she has practiced fire/emergency drills with day-care children on 08/04/2022, providing LPA with disaster drill log. Licensee has a working telephone.

Detergents and cleaning supplies were inaccessible. Fire extinguisher has been serviced in the last year, card on extinguisher notes 03/07/2022. There is an operational smoke detector and carbon monoxide in the home The home has electrical outlet covers throughout and maintains a First Aid Kit. There are adequate age appropriate toys, books, and games. There are no firearms present on the premises as stated by licensee. LPA inspected the backyard and found the garage locked. There are no pools or spas, or other bodies of water. Currently there are no pets.

SUPERVISOR'S NAME: Guangorena Claudia	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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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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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIM FAMILY CHILD CARE	FACILITY NUMBER: 198016640
	VISIT DATE: 08/26/2022

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Children's Roster is readily available and updated . Children’s Files were reviewed.

The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.

LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space.

A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.

Incidental Medical Services are not provided at this time. Licensee was informed to contact the department 30 days prior to enrolling any child with IMS needs.

LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee, Young Kim. 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: 08/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

LIC809 (FAS) - (06/04)

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