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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017944
Report Date: 08/11/2021
Date Signed: 08/11/2021 09:45:29 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:KIM FAMILY CHILD CAREFACILITY NUMBER:
198017944
ADMINISTRATOR:KIM, JIN YEOUNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 494-4213
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:14CENSUS: 2DATE:
08/11/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jin Yeoun KimTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Hawkins arrived at the facility on 8/11/21 at 8:45 a.m. for the purpose of conducting a proof of correction inspection. LPA observed licensee Jin Yeoun Kim, and assistant Eunice Kim caring for two children (2 preschoolers) at 8:45 a.m.; three additional children (3 infants) arrived at the facility between 9:00 a.m. -9:10 a.m. Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are two adults and no minor children living in the facility.

During today’s inspection, LPA and licensee toured the inside areas identified in the facility sketch as accessible to child care children. Off limits areas are made inaccessible by means of children safety gates, located at the entrance of the day care room, both entrance to the kitchen and family room. The purpose of the inspection was to verify a proof of correction citation for facility operating over capacity that was issued on 8/2/21. LPA reviewed facility roster, and observed 5 children (2 preschoolers, 3 infants) in care. Licensee provided an updated schedule (emailed on 8/3/21) to ensure proper scheduling to stay within compliance.
The plan of correction was verified by LPA and proof of correction letter was provided to licensee during todays inspection.
In the areas that were evaluated, No deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.
An exit interview was conducted with licensee Jin Yeoun Kim in english. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The
End of Report.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
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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