304371100-12-8-2022-06-CC-STOE-CLWVMZ-20221208153422

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371100
Report Date: 12/08/2022
Date Signed: 12/08/2022 03:34:36 PM

Document Has Been Signed on 12/08/2022 03:34 PM - It Cannot Be Edited

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:	DONG SHIN CHRISTIAN PRESCHOOL		FACILITY NUMBER:	304371100
ADMINISTRATOR:	KIM, HAEWON		FACILITY TYPE:	850
ADDRESS:	2505 E. YORBA LINDA BLVD.		TELEPHONE:	(657) 378-9653
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92831
CAPACITY:	145	CENSUS: 89	DATE:	12/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Haewon, Kim, Director		TIME COMPLETED:	03:45 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), Stacy Torrence conducted an onsite inspection for the purpose of an Annual visit. LPA and staff toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken. There were 89 preschool children with 14 staff supervising. During the inspection, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 7:30a.m.- 6:00p.m., Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Facility provides breakfast, lunch, and PM snack. Drinking water is available to children indoors by children bringing their own water bottles from home with the child’s name on it and each classroom has a filter water jug for refills. The children's bathrooms are clean and sanitary. Children nap on mats, and bedding is stored individually and is washed weekly by the parents. The facility has conducted an emergency drill within the past six months. The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility. Staff files were reviewed for staff present during the facility inspection on this date, 6 staff files were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles, staff files were in compliance. Staff 1 did not have proof of Health-Screening in file. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training. Staff 3 did not have a current Mandated Reporter Training certificate in file. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 05/23 .

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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: DONG SHIN CHRISTIAN PRESCHOOL	FACILITY NUMBER: 304371100
	VISIT DATE: 12/08/2022

NARRATIVE

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Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 6 children's files were reviewed. In the areas reviewed the children’s files were found to be in full compliance. Sign in/out procedure was reviewed and facility was not in compliance.

LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 outdoor activity space was inspected for compliance. The playground is completely fenced. The surface of the outdoor activity space was well maintained and free of hazards. Appropriate cushioning material was observed around and under play equipment. Drinking water is available to children outdoors by child’s water bottles and there is a jar with filter water for refills. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The facility representative was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov facility representative may request to be added to an email list to receive a Quarterly Update from www.ccld.ca.gov and select Receive Important Updates link.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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: DONG SHIN CHRISTIAN PRESCHOOL	FACILITY NUMBER: 304371100
	VISIT DATE: 12/08/2022

NARRATIVE

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Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The facility representative was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.

LPAs discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Based on LPAs records reviews, the following violations were observed and are being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101216(g)(2) Personnel Requirement and Health and Safety 1596.8662(b)(1) Administration of Child Day Care Licensing are being cited on the attached LIC 809D.

An Inspection and exit interview were completed with facility representative. The report was reviewed and discussed. Appeal Rights was discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) 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.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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: DONG SHIN CHRISTIAN PRESCHOOL	FACILITY NUMBER: 304371100
	VISIT DATE: 12/08/2022

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5

Document Has Been Signed on 12/08/2022 03:34 PM - It Cannot Be Edited

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: DONG SHIN CHRISTIAN PRESCHOOL	FACILITY NUMBER: 304371100
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that S3 did not have proof of current Mandated Reporter Training certificate in file, which poses a potential safety risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Per director, she will submit S3's current Mandated Reporter Training certificate to LPA by POC due date

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, licensee did not comply with the section cited above in that S1 did not have a health-Screening report in file which poses a potential health risk to persons in care.
	POC Due Date: 01/09/2023
	Plan of Correction
1 2 3 4	Per director, she will submit S1's LIC 503 Health Screening report to LPA by POC due date

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: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC809 (FAS) - (06/04)

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