304371100-7-30-2024-06-CC-AFCN-D7NRP8-20240730131131

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371100
Report Date: 07/30/2024
Date Signed: 07/30/2024 01:13:20 PM

Document Has Been Signed on 07/30/2024 01:13 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
ORANGE COUNTY CC RO, 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:	217	CENSUS: 89	DATE:	07/30/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Director Haewon Kim		TIME COMPLETED:	01:30 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	On 07/30/24, Licensing Program Analyst (LPA), Anna Chan conducted an unannounced onsite inspection for the purpose of an Annual Required visit. LPA met with director Haewon Kim. LPA and director toured the facility inside and outside, and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 89 preschool children and 11 staff members. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staff to child 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. Breakfast, Lunch and PM snacks are provided by the facility. Food is prepared on site. Food prep areas were clean and sanitary. Food is properly stored. Menus were posted near the entrance of the facility where it could be seen by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by filtered water and children have their own sports bottles properly labeled with their names, the children's bathrooms were clean and sanitary. The facility has conducted an emergency drill within the past six months on May 08, 2024. 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. Page 1 of 3

SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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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Document Has Been Signed on 07/30/2024 01:13 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
ORANGE COUNTY CC RO, 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: 07/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. Facility conducted Lead Sampling on January 14, 2023, which is past the 1/1/23 deadline, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/21/2024
	Plan of Correction
1 2 3 4	Facility conducted Lead testing on 1/14/23.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: DONG SHIN CHRISTIAN PRESCHOOL	FACILITY NUMBER: 304371100
	VISIT DATE: 07/30/2024

NARRATIVE

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5 Staff file were reviewed for staff present during the facility inspection on this date. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1596.7995 (a)(1) 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. Proof of immunization against pertussis, measles for the facility were reviewed and within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 05/2025

5 Children's records were reviewed, and there was a separate, complete, and current record for each child. The facility utilizes Procare app for sign in and out. Each child representative has their own login ID. In the areas reviewed the children’s files were found to be in full compliance.

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. Facility conducted Lead Testing on January 14, 2023.

Currently, there are no medications in the facility and was reviewed for compliance. This facility provides Incidental Medical Services (IMS) 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

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SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: DONG SHIN CHRISTIAN PRESCHOOL	FACILITY NUMBER: 304371100
	VISIT DATE: 07/30/2024

NARRATIVE

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The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material in the playground is turf grass around the climbing structure such as slide and other climbing equipment which appears to be enough to absorb falls. There is also a shaded paved area for bicycles. Drinking water in the outdoor activity space is provided by filtered water and refillable sports bottles with the child’s name on it. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility, and none was observed during today’s visit.

Transfer Request (LIC9182). The director was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov Site Supervisor may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

In the areas that were evaluated, a Type B deficiency was observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. HSC 1597.16(a)(1). Please see LIC 809D for deficiency

An Inspection and exit interview were completed with Director, Haewon Kim. The report was reviewed and discussed. Appeal Rights and deficiency were 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.

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SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC809 (FAS) - (06/04)

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