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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006937
Report Date: 09/03/2026
Date Signed: 09/03/2026 11:28:49 AM

Document Has Been Signed on 09/03/2026 11:28 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:KIM FAMILY CHILD CAREFACILITY NUMBER:
198006937
ADMINISTRATOR/
DIRECTOR:
KIM, EUNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 388-1576
CITY:LOS ANGELESSTATE: CAZIP CODE:
90004
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
09/03/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Licensee Eun KimTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On Thursday, September 3rd, 2026 at 9:15 a.m., Licensing Program Analyst (LPA) C. Nguyen conducted an unannounced annual inspection and met with licensee Eun Kim, whom the purpose of the visit was explained, and guided LPA on a tour of the facility. Also present is Licensee’s assistant who assisted with translation because licensee speaks Korean. Entrance Checklist LIC 126 was provided. Licensee states that there are 7 children enrolled. LPA observed 5 children which facility to be within ratio. Licensee stated operating hours are Monday to Friday from 8 a.m - 6 p.m.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, and living room (main care room), and backyard. Family members residing in the home were discussed (criminal record clearances on file) and names listed on form Confidential Names LIC811. The LPA toured all areas used by children during this visit. For ill isolation, licensee stated that she will call parents to pick them up and they are isolated with another teacher, separate from the other children; the dining area is utilized. LPA observed the first aid kit on the premises.
Areas accessible to children include: use bathroom in the hallway, the living room (main care area), dining area, kitchen, and backyard (fenced).
Areas inaccessible to children: 3 bedrooms and master bathroom.

LPA observed the following required postings in the entryway of the facility: License, LIC 9148 Earthquake Preparedness Checklist, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, and LIC 999 Facility Sketch.
Page 1 of 4
Katrina Chicote
Caroline Nguyen
DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KIM FAMILY CHILD CARE
FACILITY NUMBER: 198006937
VISIT DATE: 09/03/2026
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LPA inspected the facility for safety, comfort, cleanliness, ventilation and working cell phone and landline phone. For ventilation, LPA observed ceiling fans and AC units. At 9:30 a.m., Licensee began the tour starting with the entrance of the door where parents and children enter from which lead directly to the living room which is the main day care room. LPA observed the furniture, manipulatives, books, soft plush toys, puzzles, art materials and other age-appropriate materials that were well maintained and free of loose, sharp, and pointed parts. Napping equipment in the form of cots were observed and licensee states that parents bring and wash the linen every 2 weeks. There is a barricaded fireplace in the living room and licensee states it is not operable. LPA also observed a diaper changing table. There is a closet in the living room which LPA inspected and did not observe any hazardous items inside. The dining room is adjacent to the living room and more age-appropriate furniture and materials were observed. The are children’s table/chairs, sofas, TV, and a bookshelf with children books.

Next, LPA inspected the kitchen which is adjacent to the dining area. LPA observed the knives, sharp objects, and medication stored inside a top cabinet making it inaccessible for children to reach. LPA advised licensee that they should be move to more inaccessible area if she has older children in care. LPA inspected the drawers and cabinets and did not observer ay hazardous materials. Licensee stated the facility provides lunch and snack and utilizes a food program. LPA informed licensee that any food brought from the children's homes, shall have the container labeled with the child's name and properly stored or refrigerated. Licensee stated that there are no children with severe food allergies nor on medication. Licensee also stated that children only access the kitchen with supervision only to use the restroom. LPA advise to place a child-safety gate to ensure inaccessibility.



At 10:00 a.m., LPA entered the bathroom in the hallway and observed a working toilet, and working sink with hand soap. LPA reminded licensee and personal items (ex; shampoo, toothpaste, mouthwash, or items that fall into that category) must be made inaccessible to children. LPA inspected the drawers and cabinets and did not observe any hazardous materials.

Currently, children are using the backyard for outdoor play time. The backyard entrance is through the front patio with gate and licensee states that there is always supervision when they have outdoor time. The outdoor play area was observed to be fenced around the perimeter and side gates locked and closed. LPA observed toys, play house, bicycles, age-appropriate structures, and the area to have artificial grass. All play equipment is age-appropriate and in safe condition (free of sharp, loose, or pointed parts). Also observed is shed with lock making it inaccessible.


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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Caroline Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KIM FAMILY CHILD CARE
FACILITY NUMBER: 198006937
VISIT DATE: 09/03/2026
NARRATIVE
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LPA asked the licensee if there were any pets, poisons, firearms, or weapons, or bodies of water. Licensee stated they do not have any of the other above-mentioned and LPA did not observe any. The licensee was informed that if any poisons (ex; drano, rat poison or items that fall into that category), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

At time of inspection, LPA observed the fire extinguisher located in the kitchen and the valve on the green area indicating fully charged and last serviced on 1/9/2026. Per State Fire Marshall standards, fire extinguishers shall be serviced or purchased with receipt annually. LPA informed licensee disaster drills shall be conducted every 6 months and LPA observed the last emergency drill conducted on 08/2026. LPA observed Licensee test a combined carbon monoxide detector and smoke alarm located in the dining room.

LPA observed licensee’s American Heart Association Pediatric First Aid/ CPR certification and expires 10/2026, and has proof of immunization against Pertussis, MMR, and Influenza declination. Licensee has completed the Child Abuse Mandated Reporter (AB 1207) training and expires 01/02/2028. Licensee was advised that the Pediatric First Aid/ CPR certification and mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com.



LPA also reviewed children’s roster, children files including sleep logs and licensee/assistant files. LPA observed the files to be complete. LPA provided consultation for record keeping and qualifications.

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-andresources/safe-sleep as an additional resource.


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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Caroline Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KIM FAMILY CHILD CARE
FACILITY NUMBER: 198006937
VISIT DATE: 09/03/2026
NARRATIVE
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LPA also informed licensee of the importance of checking for and removing any 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 did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, trampolines, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family child care facility.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. When any IMS is provided, 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

During the exit interview, licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

The Notice of Site Visit (LIC 9213) – A notice of site visit was given and must remain posted for 30 days.


Appeal Rights provided to licensee. Exit interview conducted and report was reviewed with the licensee Eun Kim and assistant Boyoon Chang.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Caroline Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
LIC809 (FAS) - (06/04)
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