198017160-1-28-2020-33-CC-JHUA-BL9P9M-20200128100722

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017160
Report Date: 01/28/2020
Date Signed: 01/28/2020 10:07:33 AM

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:	GU FAMILY CHILD CARE		FACILITY NUMBER:	198017160
ADMINISTRATOR:	GU, BONG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 633-6856
CITY:	ROWLAND HEIGHTS	STATE: CA	ZIP CODE:	91748
CAPACITY:	14	CENSUS: 5	DATE:	01/28/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Bong Gu		TIME COMPLETED:	10:15 AM

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	Annual inspection conducted by LPA Jennifer Hua. LPA met with licensee, who guided LPA on a facility tour. Licensee speaks primarily Korean and some English. The facility is single-story home. Per licensee, total of 5 adults and 0 minor reside in the home. Licensee's son Byyeongguk Kim assist with day care today because regular assistant is not coming today. Areas accessible to children were inspected as follows: Living room, front bedroom, bathroom inside the bedroom. Fenced front yard. Per licensee, there are no weapons, firearms, swimming pool or spa on the premises. There are age appropriate toys and equipment on the premises. The smoke/carbon monoxide detectors and fire extinguisher (2A 10BC) are in operable condition. Extinguisher was serviced on 9/18/19. Areas off limits include: The rest of the home - 2 bedrooms, 1 bathroom, kitchen, fenced backyard and garage. -Licensee has current certificate in Pediatric First Aid/CPR which will expire on 8/18/20. -Child Care Roster, Disaster Plan, Children records and required licensing forms were reviewed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement. The following was discussed: Individuals who are 18 years of age or older living/working in the home must be finger print cleared. Individuals within one month of their 18th birthday must be fingerprinted immediately. The existing, immediate $100 per individual Civil Penalty has been increased to an immediate $100 per day Civil Penalty, for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations. If an individual has a clearance with the Department a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020

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: GU FAMILY CHILD CARE	FACILITY NUMBER: 198017160
	VISIT DATE: 01/28/2020

NARRATIVE

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Rooms that are off-limits need to be made inaccessible during operating hours. No smoking, No infant walkers, Johnny jumpers, exersaucers, bouncers and any other item that falls into that category, earthquake – fire, disaster drills and safety, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal records, child abuse clearance and criminal records transfer requirements, SIDS, Never Shake A Baby, A Child Care Provider's Guide to Safe Sleep was provided to licensee. Per licensee, children currently enrolled are over age 1. Children nap on mats. LPA observed affidavit for liability insurance form in children's files. Drills were conducted 1/8/20. Licensee was informed to complete the Mandated Reporter Training on department website at http://www.mandatedreporterca.com/ when training is available in her language.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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) 514-0388 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

· Dog(s) and or pets should be isolated from children in care. No pets observed.
· It is recommended that a First Aid kit be available on premises.
Outdoor supervision required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors.

No deficiency cited.

Exit interview was conducted with licensee. Site visit notice posted. And Licensee advised to keep notice posted for 30 days or a civil penalty of $100 will be assessed.
Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020

LIC809 (FAS) - (06/04)

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