197494858-10-26-2021-33-CC-SLEE-C86QUH-20211026122845

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494858
Report Date: 10/26/2021
Date Signed: 10/26/2021 12:28:54 PM

Document Has Been Signed on 10/26/2021 12:28 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	CHO FAMILY CHILD CARE		FACILITY NUMBER:	197494858
ADMINISTRATOR:	DA CHO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 503-4878
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90005
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	10/26/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Da Cho		TIME COMPLETED:	12:30 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	Licensing Program Analyst (LPA) Seung Lee conducted a announced prelicensing inspection. Upon arrival LPA Lee met with applicant Da Cho. who provided the LPA on a tour of the home. The purpose of the inspection was to inspect the home for a pending small family child care home application. During the inspection all areas identified on the facility sketch were inspected. This large family child care home is located in a two story 5 bedroom, 4 bathroom home. Adults residing in the home is just the Licensee. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. There are age appropriate toys and napping equipment on the premises. Per applicant there is a no fire arm in the home. The applicant does not have any pets. The areas of the day care will be the living room area, 1 bathroom on first floor, 2 bedrooms on the first floor, and backyard. Areas off limits to children will be kitchen, and all of the second floor. Applicant stated she will provide care for children ages 0 to 5 years old. Hours of operation will be Monday-Friday 8AM to 6PM. During the inspection LPA Lee observed that the back unit/ADU located in the backyard had a separate address of 749 S WIndsor Blvd. LPA Lee observed that the deed of the home with the applicant's name does not include the additional address. During the walk through LPA Lee inspected the back unit. The applicant stated that she only she lives in the property which includes both addresses. The applicant stated that she will provide paperwork to confirm that this is the case.

SUPERVISORS NAME: Guangorena Claudia
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CHO FAMILY CHILD CARE	FACILITY NUMBER: 197494858
	VISIT DATE: 10/26/2021

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
26
27
28
29
30
31
32

LPA Lee observed an operational smoke and carbon monoxide detector located near the front door. The fire extinguisher was observed to be operational but the applicant was not able to provide a receipt with a date.

FORMS TO BE POSTED
LIC6101A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster,
Facility License
Facility Records: LIC 624B Unusual Incident/Injury Report,LIC 9040 Child Care Facility Roster, LIC 9052 Employee Rights,LIC 9108 Statement Acknowledging Requirement to Report Child Abuse,
Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Immunization records. Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).
Children’s records requirements: LIC 700 Identification And Emergency Information, LIC 627 Consent For Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children In Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights

The following was discussed with the applicant:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification,TB clearance, and a valid criminal record clearance associated to the facility license.
A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.

SUPERVISORS NAME: Guangorena Claudia
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021

LIC809 (FAS) - (06/04)

Page: 2 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CHO FAMILY CHILD CARE	FACILITY NUMBER: 197494858
	VISIT DATE: 10/26/2021

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
26
27
28
29
30
31
32

Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements was reviewed and explained.
Fire and safety drills must be performed every month and documented for review by the Department.
Smoking is prohibited in a family child care home, 24/7.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
All adults living and working in the home shall be made of aware of the Departments right to inspection authority.

Once licensed applicant was informed to contact the department 30 days prior to enrolling any child with IMS needs. LPA advised applicant to refer to Section 101173 and 101226 for further information on regulatory requirements. Regulation Interpretations and Procedures for Child Care Centers Section 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.

Once licensed, the applicant is required to adhere to the terms and limitation as stated on the license.
LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

The applicant will need to provide paperwork regarding the back unit with a separate address and a receipt for the fire extinguisher. The applicant was informed that the application will forward once the corrections have been made. Exit interview conducted with applicant Da Cho. Appeal rights discussed and explained.

SUPERVISORS NAME: Guangorena Claudia
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3