198017944-8-2-2021-06-CC-JHAN-C6QVG7-20210910162505

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198017944
Report Date: 08/02/2021
Date Signed: 08/02/2021 12:12:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2021 and conducted by Evaluator Sherene Hawkins

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20210722113546

FACILITY NAME:	KIM FAMILY CHILD CARE		FACILITY NUMBER:	198017944
ADMINISTRATOR:	KIM, JIN YEOUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 494-4213
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY:	14	CENSUS: 10	DATE:	08/02/2021
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Jin Yeoun Kim		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility is operating over capacity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Hawkins initiated the complaint investigation on 8/2/21 at 9:35 am and conducted an inspection of the home. Upon arrival at 9:35 am, LPA met with licensee Jin Yeoun Kim. Present in the home at the time of inspection was Licensee and assistant Eunice Kim who was observed caring for ten children (5 preschoolers, 5 infants). A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA toured the home, informed the licensee of the allegation and conducted an interview, obtained a current roster and reviewed children's files during todays inspection. On 7/22/21 the Department received a complaint alleging that the facility was operating over capacity. It was reported that the facility is providing care for a total of 10-12 children daily with approximately 8 of the children being infants.

**continued on page 2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021

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 06-CC-20210722113546

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 198017944
	VISIT DATE: 08/02/2021

NARRATIVE

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During the investigation, upon review of facility children's roster and files, and observation at 9:35 AM in the classroom (bedroom), it was determined that the facility was operating over capacity with ten children (5 infants, 5 preschoolers) during today's inspection. This posses an immediate health and safety risk to the children in care. Therefore, the preponderance of evidence standard has been met, therefore the above allegation of facility operating over capacity is found to be substantiated.
This facility is not in compliance with California Code of Regulations, Title 22, Division 12 Section 102416.5(d)(1) Staffing Ratio and Capacity deficiency is being cited on the attached LIC 9099D.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Upon receipt of Type A violation, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and to the parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.”

Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above. All appeals must be in writing and received by the licensing office within 15 business days. The first level appeal is to regional manager.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 06-CC-20210722113546

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 198017944
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/02/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/03/2021 Section Cited CCR 102416.5(d)(1)	1 2 3 4 5 6 7	102416.5(d)(1) Staffing Ratio and Capacity. For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home...shall be either: (1) Twelve children, no more than four of whom may be infants; This requirement was not met as evidenced	1 2 3 4 5 6 7	Licensee stated she will inform parents that schedules have to be adjusted to ensure facility is in compliance at all times. Licensee will provide written updated schedule of children enrolled. Licensee will email proof of updated schedule to LPA Hawkins by due date 8/3/21. Email: Sherene.Hawkins@dss.ca.gov
	8 9 10 11 12 13 14	by facility was operating over capacity@ 9:35am with Licensee and assistant caring for 10 children (5 infants and 5 preschoolers) during todays inspection. This poses an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14
	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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021

LIC9099 (FAS) - (06/04)

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