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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313243
Report Date: 05/01/2019
Date Signed: 05/01/2019 03:32:42 PM

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:YOO, SU YOULFACILITY NUMBER:
304313243
ADMINISTRATOR:YOO, SU YOULFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 882-9425
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:14CENSUS: 8DATE:
05/01/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:56 PM
MET WITH:Su YooTIME COMPLETED:
03:45 PM
NARRATIVE
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An inspection was conducted at the facility by Licensing Program Analyst (LPA) Stacy Torrence. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

According to licensee, there are presently two adults and two children living in the home. During today’s inspection, the home was toured, and the licensee was operating within the licensed capacity. Present during today's inspection was the Licensee, Su Yoo and Licensee’s Assistant Jennifer Jung. There were eight children present today. LPA observed six children napping. Licensee currently have eleven children enrolled. Current children’s roster was available. This is a two-story home which consists of four bedrooms, two and half bathrooms, living room, family room, kitchen, laundry room, front yard (not fenced), back yard(fenced), and garage. The floor plan was verified. Off limit areas include: entire upstairs, kitchen, front yard, and garage. The main day care areas are the living room and family room. The licensee's and licensee's assistant pediatric CPR/First Aid certification are current. Items which could pose a danger to children were not accessible to children. Poisonous items were not observed during today's inspection. The smoke detector and carbon monoxide were tested and are operable. Fire extinguisher is fully charged. Emergency Disaster drill log within the past six months was available. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit.
Children's records: parents' rights and California School Immunization Record were reviewed.
Incidental Medical Services-IMS was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. 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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
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 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YOO, SU YOUL
FACILITY NUMBER: 304313243
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2019
Section Cited
HSC
1596.622(a)(1)
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1597.622(a)(1) Employee and Volunteer Immunization. Commencing September 1, 2016, 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, .......
The requirement is not met as evidence by record review of Staff #1 is missing proof of
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Per Licensee, she will have Staff #1 obtain proof of immunization and maintain copy on file. A copy of the immunization record will be submitted to LPA by POC due date of 05/15/19.
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Pertussis. This poses risk to the health of 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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
LIC809 (FAS) - (06/04)
Page: 3 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: YOO, SU YOUL
FACILITY NUMBER: 304313243
VISIT DATE: 05/01/2019
NARRATIVE
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Licensee had proof of immunization against Pertussis, Measles, and Influenza; however, Licensee’s Assistant does not have proof of Pertussis immunization. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the licensee.
Licensee and Licensee's assistant have completed the mandated reporter training and during this inspection licensee gave copies of certificate to LPA.

The following deficiency was cited per CA Code of Regulations Title 22-refer to the 9099D.

Exit interview was conducted. Report reviewed and discussed with the licensee. Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Licensee was informed how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.


SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3