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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198009114
Report Date: 02/04/2025
Date Signed: 02/04/2025 01:37:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/18/2024 and conducted by Evaluator Jonnisha Culbert
COMPLAINT CONTROL NUMBER: 54-CC-20241218094651
FACILITY NAME:CPC PRESCHOOLFACILITY NUMBER:
198009114
ADMINISTRATOR:KIM SUNG MEEFACILITY TYPE:
850
ADDRESS:11840 E. 178TH ST.TELEPHONE:
(562) 246-0360
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY:90CENSUS: DATE:
02/04/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:TIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Facility did not react to child allergic reaction

Facility did not report allergic reaction to parent
INVESTIGATION FINDINGS:
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On 02/04/2025 Licensing Program Analyst (LPA) Jonnisha Culbert conducted an unannounced complaint investigation visit at the facility mentioned above. LPA met with Director Kim Mee Sung, stated the purpose of the visit is to conclude this agency’s investigation into the complaint allegations mentioned above. Director guided LPA on a tour of the facility. At the time, Director, 11 staff, and 84 children were present.

During the investigation, interviews were conducted, a review of facility and children records were completed, photos were collected, and copies of pertinent documents such as the facility menus were obtained.

Per the report submitted to the Department, Child 1 had an allergic reaction at the facility on 9/10/24 and the facility did not tend to the incident, nor did they notify Child 1’s parent. Interview conducted with Staff

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 54-CC-20241218094651
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CPC PRESCHOOL
FACILITY NUMBER: 198009114
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/05/2025
Section Cited
CCR
101226(a)(b)
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The licensee shall immediately notify the child's authorized representative if the child becomes ill... licensee shall make prompt arrangements for obtaining medical treatment... This requirement was not met as evidence by:
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Director provided LPA J. Culbert with a signed pledge to train staff on identifying allergic reactions and when to report incidents to parents. Per signed letter, Director and staff will complete the training and email LPA certificate proof of all staff who completed training by 02/28/2025
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Based on interview, Child 1 had a swollen lip and licensee did not notify the child’s parent nor did they administer medication prescribed to child which poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 54-CC-20241218094651
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CPC PRESCHOOL
FACILITY NUMBER: 198009114
VISIT DATE: 02/04/2025
NARRATIVE
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revealed that the allergic reaction began 20 to 30 minutes after the afternoon snack. Per Staff 1, peanut butter and jelly sandwiches were served on 9/10/24. LPA’s review of the facility’s menu for September 2024 confirmed that peanut butter and jelly sandwiches were served on 9/10/24. Staff 1 stated that they noticed Child 1’s lip was swollen and stated that Child 1 did not eat the snack provided. Per Staff 1, they informed the Director of Child 1’s lip but child 1’s medication located in the Director’s office was not administered. Staff 1 and Director confirmed that they did not contact Child 1’s parent about the incident. The Director stated that they did not think Child 1 was having an allergic reaction because only the lip was swollen Staff 1 and Director confirmed they were aware that Child 1 had a documented allergy to peanut butter. LPA review of the allergy list kept at the facility verified that Child 1’s allergy was documented. The information provided by all parties interviewed is consistent in establishing that the facility did not respond to child 1’s allergic reaction and their parent was not contacted.


Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated.

The facility is being cited one Type A deficiency for failing to protect the personal rights of a child in care, in accordance with Title 22, California Code of Regulations. (See LIC 9099D). A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy signed acknowledgement of Receipt (LIC 9224) shall be in each child’s file, acknowledging receipt. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

Appeal rights were provided and exit an interview was conducted with Director Sung Mee Kim.



The notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC9099 (FAS) - (06/04)
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