198016911-5-21-2021-54-CC-CGUA-C38UYX-20210521160036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198016911
Report Date: 05/21/2021
Date Signed: 05/21/2021 03:41:11 PM

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 CENTER DR 200B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2021 and conducted by Evaluator Seung Lee

COMPLAINT CONTROL NUMBER: 54-CC-20210125143615

FACILITY NAME:	SMALL WORLD OF JOY		FACILITY NUMBER:	198016911
ADMINISTRATOR:	SHIN, SEOUNG		FACILITY TYPE:	850
ADDRESS:	932 S. PARK VIEW STREET		TELEPHONE:	(818) 653-3660
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90006
CAPACITY:	40	CENSUS: 5	DATE:	05/21/2021
		UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Seoung Shin		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Daycare child was inappropriately touched by another child causing injury while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Seung Lee contacted the facility via telephone to initiate the 10-day complaint investigation due to COVID-19 and pre-cautionary measures. LPA Lee identified himself and spoke to Director Seoung Shin and discussed the purpose of the call.

During the course of the investigation the department conducted interviews, reviewed documents, and made observations in regard to the above allegation.

This department has investigated the allegation that Daycare child was inappropriately touched by another child causing injury while in care.. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

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 54-CC-20210125143615

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SMALL WORLD OF JOY	FACILITY NUMBER: 198016911
	VISIT DATE: 05/21/2021

NARRATIVE

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An exit phone interview has been conducted with Director Seoung Shin. Appeal Rights were verbally explained to Director as well. A copy of this report has been signed by LPA Seung Lee. This report and Appeal Rights will be scanned via e-mail to Director Seoung Shin, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. A hard copy of this report, form LIC 9224 and the Appeal Rights has been placed in today’s mail and Director agrees to sign the bottom of each page of the 9099 and return the originals to LPA Lee in-person or via U.S. Mail.

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SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

LIC9099 (FAS) - (06/04)

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