198010349-9-9-2021-54-CC-KCHE-C6PTFK-20210909144140

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010349
Report Date: 09/09/2021
Date Signed: 09/09/2021 02:42:01 PM

Document Has Been Signed on 09/09/2021 02:42 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	KIM FAMILY CHILD CARE		FACILITY NUMBER:	198010349
ADMINISTRATOR:	KIM, JEA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 487-7735
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90015
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 8	DATE:	09/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Licensee, Jea Kim		TIME COMPLETED:	03:00 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)Katrina Chicote conducted an Unannounced Required Annual inspection to the above facility on 09/09/2021 at 12:00 PM. LPA Chicote conducted a COVID-19 Screening Call prior to entering the facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Jea Kim, who guided the LPA on a tour of the facility. Also present were two adults, who are Licensee's assistants.There are three adults living in the home and all have criminal record clearance. There were eight day care children present during today’s inspection. Licensee states that there are currently nine children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 8am-6pm, Monday thru Friday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 08/10/2021. This is a two-story home which consists of three bedrooms and two bathrooms, kitchen, and daycare space. Areas used by the children include entire daycare space, which is the entire downstairs area, consisting of three rooms and a Bathroom. Per Licensee, areas off limits to children and parents include kitchen and entire upstairs area containing all three bedrooms and Bathroom 2. At 12:03 PM, LPA observed that there is a baby gate barricading bottom of steps making area off limits to children in care. At 12:05 PM, LPA observed a short barrier allowing adults to walk over and gain entry but blocking entry way for children, making Kitchen off limits at time of inspection. All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. Upon entry of the home, you walk into foyer where LPA observed children's cubbies for their belongings. LPA observed child size tables and chairs, play kitchen, shelving filled with puzzles, plastic cars, and other age appropriate toys, free of loose and sharp parts in all three rooms used for daycare space. At 12:08 Report continues- Page 1 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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 7

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KIM FAMILY CHILD CARE	FACILITY NUMBER: 198010349
	VISIT DATE: 09/09/2021

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

PM, LPA observed standard blue mats and standard blue cots used for napping stored in daycare space. LPA observed electrical cover outlets all through the home. At 12:10 PM, LPA observed Bathroom 1, which will be used by the children to be in the left rear of the home to have two child size toilets, two sinks, adequate handwashing supplies, and to be free of hazards. Per Licensee, there are no pets and LPA did not observe any pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. At 12:12 PM, LPA observed Clorox wipes and disinfectant spray to be kept on a high counter upon entry of the home. The Licensee states that there are no poisons in the home and all knives are kept in off limits Kitchen. The Licensee does understand that poison must be locked with a key or combination lock.

Per Licensee, the children will have access to backyard area for outdoor play. At 12:18 PM, LPA observed outdoor play area, which is accessible through a backdoor in Bathroom 1. LPA observed backyard has concrete, turf grass and adequate perimeter fencing through-out the yard. LPA observed small plastic play structure, swing set, plastic play house, plastic slides, plastic ride along toys, and other age appropriate toys free of loose and sharp parts available for the children in the backyard and all trees, shrubs, and plants are maintained.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises or firearms in the home.
Per Licensee, they provide food for children in care. Licensee states she has updated sick policy, does temperature checks upon entry, and if a child is sick they will isolate the children from other children depending on where children are playing at time.

At 12: 20PM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged last serviced on 10/19/2020. At 12:07 PM, LPA observed smoke and carbon monoxide detectors are in operable condition at time of inspection. At 12:04 PM, LPA observed First Aid kit kept hanging on right wall of entrance and was inventoried for necessary supplies. The Licensee has current Pediatric First Aid and CPR. At 12:23 PM, LPA discussed mandated reporter training, which was expired at time of inspection. Proof of immunization readily available at time of inspection.
—CPR Card valid until: 11/2022
—Mandated Reporter AB1207 Completed: 03/17/2018

Report continues- Page 2 of 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

Page: 2 of 7

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KIM FAMILY CHILD CARE	FACILITY NUMBER: 198010349
	VISIT DATE: 09/09/2021

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

The following were discussed:
Incidental Medical Services (IMS)
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Licensee (or facility representative) was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. A hard copy of PIN 21-25-CCP, PIN 20-24-CCP, PIN 21-15-CCLD, and LIC 9227.

Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/www.mandatedreporterca.com

Report Continues - Page 3 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

Page: 3 of 7

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KIM FAMILY CHILD CARE	FACILITY NUMBER: 198010349
	VISIT DATE: 09/09/2021

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

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Jea Kim.

Report Ends - Page 4 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

Page: 4 of 7

Document Has Been Signed on 09/09/2021 02:42 PM - It Cannot Be Edited

Created By: Katrina Chicote On 09/09/2021 at 01:58 PM

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: KIM FAMILY CHILD CARE	FACILITY NUMBER: 198010349
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/09/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in Licensee having expired mandated reporter training and other staff members LPA osberved providing care for children did not have proof of mandated reporter training available at time of inspection.
	POC Due Date: 09/15/2021
	Plan of Correction
1 2 3 4	Licensee states they will provide photo proof of completion of training to LPA via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Trevino Cochran

LICENSING EVALUATOR NAME:

Katrina Chicote

LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

Page: 6 of 7