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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420260
Report Date: 06/05/2024
Date Signed: 06/05/2024 10:38:08 AM

Document Has Been Signed on 06/05/2024 10:38 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:PARK, CHEONFACILITY NUMBER:
013420260
ADMINISTRATOR/
DIRECTOR:		PARK, CHEONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 482-1798
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Cheon ParkTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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On June 5, 2024 at 8:50 AM Licensing Program Analyst (LPA) Janai McClain met with Licensee Cheon Park for an Unannounced Annual Inspection. Present during the inspection was her fingerprinted cleared spouse. There were no children in care. The home was toured for a health and safety inspection. The facility operates from 7:30am – 5:15pm Monday through Friday.


The home is a one story house that consists of two bedrooms, two bathrooms, a kitchen, living room, shed, garage, and backyard. The inside of the home was neat and clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be inaccessible to children.

ON LIMITS AREA: The bedroom on the left, living room, and hallway bathroom.
OFF LIMITS AREA: The backyard, bedroom on the right, garage, kitchen, shed and the back bathroom. Off limit areas will be made inaccessible by gates and closed and/or locked doors.
ISOLATION AREA: near the front door.

The home has a fully charged 3A40BC fire extinguisher in the living room. There are working smoke detectors and carbon monoxide detectors throughout the home. The Licensee has provided a working telephone number. Licensee's CPR and First Aid certificate expires on 10/08/2024. Per Licensee, there are no firearms in the home. Licensee is reminded to maintain a file for herself. All required forms are posted and visible for public view.
**********************************Report Continues on LIC 809-C*******************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PARK, CHEON
FACILITY NUMBER: 013420260
VISIT DATE: 06/05/2024
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The licensee was not able to provide the mandated reporter certificate.

Incidental Medical Services (IMS) policy was discussed. The Licensee is not currently providing IMS to the children in care. For IMS information see PIN 22-02. When any IMS is 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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee 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 licensee 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. LPA provided the Licensee with the Infant Safe Sleep Regulations.

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/inspection-process. **********************************Report Continues on LIC809-C******************************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PARK, CHEON
FACILITY NUMBER: 013420260
VISIT DATE: 06/05/2024
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During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

No deficiencies were cited during today's visit.

Exit interview conducted and report was reviewed with Licensee Cheon Park.
Report and Appeal Rights were provided.
A notice of site visit was given.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC809 (FAS) - (06/04)
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