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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009114
Report Date: 03/18/2025
Date Signed: 03/18/2025 02:52:31 PM

Document Has Been Signed on 03/18/2025 02:52 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CPC PRESCHOOLFACILITY NUMBER:
198009114
ADMINISTRATOR/
DIRECTOR:		KIM SUNG MEEFACILITY TYPE:
850
ADDRESS:11840 E. 178TH ST.TELEPHONE:
(562) 246-0360
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 90TOTAL ENROLLED CHILDREN: 89CENSUS: 77DATE:
03/18/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:42 AM
MET WITH:Director, Kim Sung MeeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 03/18/2025 Licensing Program Analyst Jonnisha Culbert conducted an unannounced case management deficiency visit at the facility noted above. The purpose of the visit is to address a deficiency observed during previous visit. LPA met with Director, Kim Sung Lee and stated the purpose of today’s visit. Director guided LPA on a tour of the facility. At the time of inspection Director, 8 staff, and 77 Children were present.

On 01/09/2025, LPA examined medication stored at the facility and reviewed children's files. LPA observed that Director stored medication for Child 2, Child 3, Child 4, and Child 8 in the office. Upon reviewing the files of these children, LPA discovered that a written approval and instruction from the children’s authorized representative for the administration of the medication was not in their files. This is a potential health and safety risk to persons in care. LPA informed Director of Incidental Medical Service Plan (IMS) and advised Director to have parents provide information and added it to children’s files.

California Code of Regulations, (title 22) is being cited on the attached LIC 809D. Appeal rights were provided and notice of site visit was given and must remain posted for 30 days.

exit interview was conducted with Director Sung Mee Kim.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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 03/18/2025 02:52 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 03/18/2025 at 10:42 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: CPC PRESCHOOL
FACILITY NUMBER: 198009114

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/01/2025
Section Cited
CCR
101226

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101226 Health-Related Services

This requirement was not met as evidence by:
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Director will obtain written instructions from the child's authorized representative for the administration of medication to the child. Director will email forms to LPA J. Culbert by plan of correction date.
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At the facility, LPA observed that Director stored medication for Child2, Child3, Child 4, and Child 8. During file review, LPA discovered that thier files were missing written instruction and approval from parents for administering the medication. This is a potential 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.
SUPERVISOR'S NAME:Karen Chambers
LICENSING EVALUATOR NAME:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


LIC809 (FAS) - (06/04)
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