198020429-10-4-2019-33-CC-JCHZ-BGMUYT-20191004160028

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020429
Report Date: 10/04/2019
Date Signed: 10/04/2019 04:00:38 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	SHIN FAMILY CHILD CARE		FACILITY NUMBER:	198020429
ADMINISTRATOR:	SANGHEE & INSEEK SHIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 733-0642
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90004
CAPACITY:	14	CENSUS: 0	DATE:	10/04/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Inseok Shin		TIME COMPLETED:	04:20 PM

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	A PRELICENSING INSPECTION CONDUCTED IN ENGLISH Licensing Program Analyst (LPA) Janeth Chavez conducted an announced pre-licensing inspection today. LPA met with Inseok Shin and Sarah Shin whom guided LPA on a tour of the facility indoors and outdoors. Family members residing in the home are 4 adults and no children. The applicants are Sanghee Shing and Inseok Shin. Per applicant operating hours will be Monday - Friday, 8am.-6pm. Applicant states they want to care for children 5 months to 6 years old. This is a change of location and capacity increase determination for a Large Family Child care home. The applicants are licensed at 1046 4^th Avenue, Los Angeles, CA 90019 and have met the 1- year requirement for a Large family child care home. A fire clearance was granted on 09/25/2019. This is a duplex home and the applicants live in the front home. The home in the back has a separate address of 219 S. Gramercy Place, Los Angeles, CA 90004. Per applicant, she does not currently have any other license to care for foster children or adults. All areas identified on the facility sketch were inspected. This is a one-story home which consists of 3 bedrooms, 2 full restrooms, kitchen, living room, dining room, laundry room, & den (adjacent to dining room area), backyard (fenced) and front yard (not fenced). The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The home has air conditioning throughout the house. Areas off limits include: 2 bedrooms, master bathroom, kitchen, den, laundry room & front yard. Areas used by children include: Living Room, dining room, bedroom adjacent to living room, hallway bathroom, and backyard (fenced). These areas are accessible during day care hours. LPA observed a non-operational fireplace in the living room that is barricaded. As per Mr. Shin the fireplace will not be used. Mr. Shin stated that the living room (study room), dining room (napping room), and the bedroom (infant room). LPA observed a Graco crib in the infant room and a closet that will be used to store linens. LPA provided Safe Sleep poster to Mr. Shin. Applicants were advised to keep all off-limit areas inaccessible to day care children at all times. Report continued on attached LIC 809C page 1 of 4.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

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 4

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: SHIN FAMILY CHILD CARE	FACILITY NUMBER: 198020429
	VISIT DATE: 10/04/2019

NARRATIVE

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LPA observed the hallway bathroom that will be used by the children free of hazards. LPA observed a metal safety gate in the kitchen area to prevent access to day care children. As per Mr. Shin the children will only pass through the kitchen area to access the backyard. The backyard has play structures and is covered by artificial synthetic grass. LPA observed the den area to have double glass doors and as per Mr. Shin the doors will remain locked. As per Mr. Shin the children will enter through the front door. The children will nap and eat in the dining room area. LPA inspected the kitchen and did not observe any hazardous items. Applicant stated there are no poisons in the home. LPA did not observe any poisons in the home. As per applicant the detergents and cleaning supplies will be stored in the master restroom. There are no weapons or firearms in the facility. The home has electrical outlet covers throughout the home. There are age appropriate toys and napping equipment in the home. LPA did not observe bodies of water, pools, or jacuzzies.

The required fire extinguisher (2A10BC) is full and was last serviced on (09/09/19). Smoke detector (hallway) and Carbon Monoxide (kitchen) are and are in operable condition. Per applicant there are no weapons or firearms in the facility at this time. First Aid kit is available. Mrs. Shanghee and Mr. Inseok’s Pediatric CPR/1st Aid Certification expires on 08/2021. Applicant’s are exempt from the AB 1207 Mandated Reporter training as the training is not provided in the applicant’s primary language, Korean.

Forms to be posted:
LIC6101A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster,
Facility License

Facility Records: LIC 624B Unusual Incident/Injury Report, LIC 9040 Child Care Facility Roster, LIC9052 Employee Rights, LIC9108 Statement Acknowledging Requirement to Report Child Abuse.

Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9108).

Children’s records requirements: LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children In Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights.

Report continued on attached LIC 809C page 2 of 4.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: SHIN FAMILY CHILD CARE	FACILITY NUMBER: 198020429
	VISIT DATE: 10/04/2019

NARRATIVE

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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.

During this visit, the LPA Chavez reviewed and issued Forms/Records to Keep in Your Family Child Care Home (LIC 311D) to the applicant. LPA Chavez reviewed Sudden Infant Death Syndrome (SIDS), Shaken Baby Syndrome, and safe sleep practices with licensee. *Infants should always sleep on their backs, mouths facing up, light bedding.

The following was discussed with the applicant:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
All adults working or living in the home must have their criminal record clearances on file PRIOR to working or living in the home. If finger print cleared, their clearances must be associated to facility PRIOR to working or living in the home. Failure to comply will result in an immediate Civil Penalty being assessed.
In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, and a valid criminal record clearance associated to the facility license.
A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements were reviewed and explained
Fire and safety drills must be performed every six months and documented for review by the Department.
Smoking is prohibited in a family child care home, 24/7.

Report continued on attached LIC 809C page 3 of 4.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: SHIN FAMILY CHILD CARE	FACILITY NUMBER: 198020429
	VISIT DATE: 10/04/2019

NARRATIVE

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Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No smoking, No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
All adults living and working in the home shall be made of aware of the Departments right to inspection authority

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

The following corrections are due by 10/11/2019:
1. Applicants must provide proof of Preventative Health and Safety training with 1 Hour Nutrition.
2. Applicants must provide a copy of the lease signed and dated.
3. Applicants must provide a copy of the Orientation certificate.
4. Applicants must provide proof of Measles, Tdap, and flu vaccines.

Once the corrections are cleared a final review of the application will be conducted by the Department. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

Exit interview was conducted with Inseok Shin, applicant, who is in agreement with the above. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

End of Report 4 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4