198020792-8-13-2021-33-CC-JMOA-C5UPVH-20210813113909

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020792
Report Date: 08/13/2021
Date Signed: 08/13/2021 11:39:18 AM

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:	KIM FAMILY CHILD CARE		FACILITY NUMBER:	198020792
ADMINISTRATOR:	JOYCE KIM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 249-4450
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90004
CAPACITY:	14	CENSUS: 9	DATE:	08/13/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Joyce Kim		TIME COMPLETED:	12:00 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	Licensing Program Analyst (LPA) Judy Mora conducted a pre-licensing inspection today. LPA met with applicant, Joyce Kim, who guided analyst on a tour of the facility at approximately 10:55 AM. Also present was Hea Kyung Woo, licensee's mother, who lives in the home and is the current Licensee. Family members residing in the home are 4 adults. The facility is currently operating under license #198018192. The Licensee, Hea Kyung Woo, will be retiring and daughter Joyce Kim will be taking over. There were 9 children present during this inspection, 3 being infants. The fire clearance was granted and received by the department on 08/12/21. All areas identified on the facility sketch were inspected. This is a two story home consisting of 4 bedrooms, 3 bathrooms, 2 kitchens, front yard, and backyard. There is a barricade in front of the second level stairs to prevent child access. Per applicant, the day care will use all areas located on the first floor, accept for the laundry room and kitchen. There is a kiddie gate blocking access to the kitchen and a door blocking access to the laundry room. Children will use the back yard for outdoor play. There is also a guest house in the rear side of the home. This area is inaccessible. Areas off limits to children and parents include: Entire second floor, kitchen and guest house. The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. Per applicant, there are no poisons in the home. Per applicant there are no weapons, firearms or bodies of water on the premises. There are no pets in the home. There are toys that are clean and safe for children. Emergency Disaster Plan was observed to be posted at the time of visit. The valve on the required 2A 10BC fire extinguisher indicates fully charged, serviced 05/25/21. Smoke detector and carbon monoxide detector were tested, and are in operable condition. *REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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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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: KIM FAMILY CHILD CARE	FACILITY NUMBER: 198020792
	VISIT DATE: 08/13/2021

NARRATIVE

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Applicant has completed the Health and Safety Training, including Nutrition requirement. Pediatric CPR and First Aid training was completed in 02/2023. There are first aid supplies on the premises. Applicant has completed the AB1207 Mandated Child Abuse Reporting training, certificate dated 05/27/21.

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

The following was discussed: 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.

If an individual has already obtained a criminal record clearance with the Department, the criminal record clearance may be transferred. A Criminal Background Clearance Transfer Request form - LIC 9182, Criminal Record Statement LIC 508 and a copy of the individuals identification must be submitted to transfer any criminal record clearances. Prior to submitting this form, you must call our office to verify that the individual has an active criminal record clearance.

No smoking, 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.

The following was also discussed: CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal record transfer requirements, criminal record and child abuse clearances.

*REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

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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: KIM FAMILY CHILD CARE	FACILITY NUMBER: 198020792
	VISIT DATE: 08/13/2021

NARRATIVE

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LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. The forms listed on the LIC 311D were explained and provided to the applicant during this visit.

Applicant has been advised of the following:
· 101217 (g)(9)(A)(1) - Fire and earthquake drills must to be conducted and documented every six months. Documentation must be readily available
· Any assistant left alone with children must have proof of current pediatric first aid and CPR on file (AB 1368), required immunization's and the AB1207 Mandated Child Abuse Reporting training.

Control of property was submitted to the Department. Per applicant, there are no dual licenses at this address.

LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was explained and issued to the Licensee. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained.

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

The applicant will be approved for a large family child care license upon a final file review.

Once licensed, the applicant is required to adhere to the terms and limitation as stated on the license.

Exit interview was conducted with Joyce Kim. 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

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

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