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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019997
Report Date: 02/26/2020
Date Signed: 02/26/2020 03:05:20 PM

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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CHIM FAMILY CHILD CAREFACILITY NUMBER:
198019997
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
02/26/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Leslie ChimTIME COMPLETED:
03:24 PM
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Licensing Program Analysts (LPAs) Jonah Myson and Raul Navarro conducted an unannounced annual random site inspection to the facility. Facility was also inspected for a capacity increase. Fire clearance was granted on 12/02/2019. Upon arrival, LPAs met with Licensee Leslie Chim and toured the facility. There were 4 children present. Adults residing in the home are the licensee, licensee's spouse and licensee's mother in law, and licensee's children. Licensee’s operating hours are Monday-Friday 7am-6pm.

The home is a one story, 4-Bed, 2-Bath home. The following areas are used for day-care: Living Room, 2 bedrooms, 1 bathroom, the dining room, back patio, and back yard. Off limit areas include: 2 bedrooms, 1 bathroom, garage, and the back portion of the back yard.

Licensee has the required postings on a parent board at the entrance of the facility. Licensee’s First Aid/CPR certificates are valid through 02/08/2022. Licensee has a working telephone.

LPAs inspected the areas accessible to day-care children. There are adequate age appropriate toys, books, and games. LPAs observed electrical outlets to be covered (or no exposed electrical outlets). The fire extinguisher located in the kitchen was last serviced on 10/2019. There is an operational smoke detector and carbon monoxide detector in the living room , which was tested by LPAs and found operational. The facility does have a First Aid Kit located in the kitchen. Per Licensee, there is a firearm present on the premises. LPAs observed that the firearm is kept in a off limit area of the home inside a locked safe with ammunition stored in a separate location.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Jonah MysonTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CHIM FAMILY CHILD CARE
FACILITY NUMBER: 198019997
VISIT DATE: 02/26/2020
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LPAs inspected the backyard which children used for outdoor activity. There are no pools or spas, or other bodies of water observed. Children’s roster and files were reviewed. Licensee's file was reviewed. Licensee has proof of immunization against influenza, pertussis, and measles on file. Licensee has also taken the Mandated Reporter Training as required.

The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.



No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPAs discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting. Licensee's Mandated Reporter expires 01/09/2022.

· LPAs reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. (Safe sleep concepts were provided on this date.)

· 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) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

· A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home. (Only applies to Large)
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Jonah MysonTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CHIM FAMILY CHILD CARE
FACILITY NUMBER: 198019997
VISIT DATE: 02/26/2020
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· LPAs advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov
· Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

At this time, the Licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today. LPAs will recommend the increase in capacity as the Licensee meets the requirements for an increase and the fire clearance was received and granted for 14 children on 12/02/19.

After further review by the department, Licensee will be notified if/when License is granted. Once licensed, the Licensee is required to adhere to the terms and limitation as stated on the license.

Exit interview was conducted with Licensee Leslie Chim. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Jonah MysonTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC809 (FAS) - (06/04)
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