304313239-11-20-2019-06-CC-JMHN-BJ4N9F-20191120091548

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313239
Report Date: 11/19/2019
Date Signed: 11/20/2019 09:15:56 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	PARK, EUN YOUNG		FACILITY NUMBER:	304313239
ADMINISTRATOR:	PARK, EUN YOUNG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 280-3797
CITY:	CYPRESS	STATE: CA	ZIP CODE:	90630
CAPACITY:	14	CENSUS: 12	DATE:	11/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Eun Young Park		TIME COMPLETED:	11:40 AM

NARRATIVE

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An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA), Jungmi Han. LPA observed licensee and Youngin Park, staff caring for 9 children which included 4 of infants, 5 preschool age children. At 9:30AM, 3 more preschool age children arrived at the facility. Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 3 adults (including the licensee) and 1 of minor children living in the facility. During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to child care children. Off limits areas are made inaccessible by gates between kitchen and daycare room and between living room and off limit bedrooms, bathroom, and garage.
During today’s inspection LPA observed following at infant's bedroom, bathroom, and closet:

Cleaning supply such as Clorox wipes
Hair dryer under bathroom cabinet
Shampoo and body cleanser in the bathroom tub
Iron on the closet floor (Closet door was unlocked at the time of inspection)

During today’s inspection LPA observed following at the kitchen area where children walking through the daycare room to backyard

Detergent under the kitchen cabinet
Medications such as Vitamins under the kitchen cabinet
Sharp tools in the kitchen drawers

Licensee stated children walk through the daycare room to backyard by passing through kitchen and dining room/living room area with 100 % supervision by licensee and staff. Licensee was informed to add latches on the cabinet doors to prevent children to access detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children.
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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: PARK, EUN YOUNG	FACILITY NUMBER: 304313239
	VISIT DATE: 11/19/2019

NARRATIVE

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Licensee stated the children's primary area is the child care room. There are working carbon monoxide, smoke detector, and fire extinguisher in the home that meet statutory and State Fire Marshall standards. Licensee stated there are not firearms or other dangerous weapons in the facility and none were observed during today's inspections. There is a fireplace in the daycare room barricaded by wood board and inaccessible to children in care. The home has age appropriate toys for the ages served. LPA verified there is a working cellular service. Licensee stated they use an outdoor play area. There were no poisons or other items observed which could pose a danger to children or if they were observed, they were locked or inaccessible. There are no bodies of water on the premises.

The licensee does have a current roster of children in care. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. The licensee and assistant’s Pediatric CPR/First Aid certification expired 6/19/2021.

Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensee and assistant were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years.

The licensee will not provide IMS.
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

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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: PARK, EUN YOUNG	FACILITY NUMBER: 304313239
	VISIT DATE: 11/19/2019

NARRATIVE

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The licensee understands she must be present in the facility and must ensure children in care are supervised at all times and children are not to be left in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.

CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website.
A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Document deficiencies based on POD training, the facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: Operation of a Family Child Care Home 102417 (g)(4) (see LIC 809D). Inspection, report reviewed and exit interview was conducted with licensee in Korean with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

End of Report.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: PARK, EUN YOUNG	FACILITY NUMBER: 304313239
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/19/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/19/2019 Section Cited	1 2 3 4 5 6 7	102417 (g)(4) Operation of a Family Child Care Home (g)The home shall be free from... might endanger a child. Safety precautions shall include but not be limited to (4) ...detergents, cleaning compounds...which could pose a danger..they are inaccessible to children. This requirement is not meet as evidenced by:
	8 9 10 11 12 13 14	Based on observation and interview, the licensee failed to ensure to keep the detergents and cleaning compounds inaccessible to children in kitchen and children's bathroom. This poses a potential Health and Safety risk to the children in care.	8 9 10 11 12 13 14
	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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

LIC809 (FAS) - (06/04)

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