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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198019016
Report Date: 12/18/2020
Date Signed: 12/18/2020 04:48:16 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
04/24/2020 and conducted by Evaluator Susann Sanchez
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20200424153229
FACILITY NAME:MOK FAMILY CHILD CAREFACILITY NUMBER:
198019016
ADMINISTRATOR:SOUNG MOKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 787-1141
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY:14CENSUS: 7DATE:
12/18/2020
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Soung Mok, LicenseeTIME COMPLETED:
03:57 PM
ALLEGATION(S):
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Personal Rights- Licensee handled daycare children in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced complaint inspection to the above facility via Facetime due to the COVID19 Pandemic. LPA met with Soung Mok, Licensee and delivered the findings of the complaint. LPA observed two infants and five children during the inspection.

During the investigation LPA interviewed staff, parents, and children. LPA obtained a copy of the facility roster and copies of other supporting documentation.

During interviews both staff 1 & 2 admitted the she/he grabbed child #1 arm. The above allegation is found to be Substantiated. A finding of Substantiated means that the allegation has been found to be valid because the preponderance of the evidence standard has been met.

PAGE 1


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 54-CC-20200424153229
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: MOK FAMILY CHILD CARE
FACILITY NUMBER: 198019016
VISIT DATE: 12/18/2020
NARRATIVE
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 Based on information obtained during this investigation, the following Type B deficiency listed on the attached LIC 809d are being cited in accordance with California Code of Regulations Title 22. Deficiency that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Soung Mok by telephone due to Center being closed because of the COVID19 pandemic. This report along with a copy of the appeal rights will be sent to the Licensee via email with a read receipt or confirmation of receipt of email, which will act as the Licensee signature.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 54-CC-20200424153229
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: MOK FAMILY CHILD CARE
FACILITY NUMBER: 198019016
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/25/2020
Section Cited
CCR
102423(a)(4)
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Personal Rights:To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication
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Per Licensee Soung Mok, stated that she pulled child arm to protect the child from a cat. Per Licensee there has never been an issue with the cat but will remove the cat if there is an issue in the future.
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 or aids to physical functioning. This requirement was not met as evidenced by: staff #1 admittingshe/he grabbed child 1 by the arm. This poses a potential health and safety risk to children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3