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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010349
Report Date: 06/04/2024
Date Signed: 06/04/2024 02:50:29 PM

Document Has Been Signed on 06/04/2024 02:50 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:KIM FAMILY CHILD CAREFACILITY NUMBER:
198010349
ADMINISTRATOR/
DIRECTOR:		KIM, JEAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 487-7735
CITY:LOS ANGELESSTATE: CAZIP CODE:
90015
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
06/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Jea KimTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 06/04/2024 at 12:45 PM Licensing Program Analysts (LPA) Claudia Kam conducted an Unannounced Required 1 year Annual inspection to the above facility. LPA disclosed the purpose of the inspection and met with Licensee, Jea Kim who guided the LPA on a tour of the facility.

There are 3 adults living in the home. All adults in the home were found to have criminal record clearance. There were 9 day care children present during today’s inspection. Licensee states that there are currently 12 children enrolled. The children's roster was reviewed and is current. Licensee reports that the facility’s hours of operation are 8:00 AM to 6:00 PM, Monday thru Friday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. LPA observed the disaster drill log and last drill was last conducted on 5/14/2024.

This is a two-story home which consists of three bedrooms and one bathroom upstairs, kitchen, living room, dining room, rear living room and back yard. Areas used by the children include the entry living room, rear living room, dining room, and downstairs bathroom. Entry living room or outside play area will be used for isolation of sick children. Per Licensee, areas off limits to children and parents include the kitchen and laundry room made inaccessible via a kitchen door leading to the kitchen and attached laundry room as well as a metal child gate. LPA observed that there is a metal gate at the base of the stairs making the second story bedrooms and upstairs bathroom inaccessible to children in care. LPA observed the gate at the base of the stairs to be locked 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. Plug in heaters and air conditioning were in use during inspection. Main Care Area for day care children will be the front living room which is equipped with a play house, play kitchens, and cubbies with age appropriate toys.
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: KIM FAMILY CHILD CARE
FACILITY NUMBER: 198010349
VISIT DATE: 06/04/2024
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The front living room leads to the dining room which has been converted into a class room equipped with school materials and a large table and chairs, reading nook and child size chairs for reading. The rear living room is to the right of the school room and is used for napping and play time.

The children's bathroom is off the dining room and is fully equipped with a child size toilets one for toddlers and one for older school age children and 2 sinks also of varying size. The outside play area is accessed via the rear of the bathroom door. LPA observed the yard to have adequate perimeter fencing through-out the property enclosing the play area and a metal gate making the drive way area inaccessible to the children. LPA observed all play equipment and concrete flooring to be free of loose and sharp parts and maintained at time of inspection. The outdoor play area is equipped with infant swings, multiple ride on cars, slides for all ages infant and preschool, and a play house. There is a working land line and cell phone maintained at the facility.

The valve on the required 2A 10BC fire extinguisher indicates fully charged, and was last serviced on 1/23/2024. LPA unable to check smoke and carbon monoxide detectors at time of inspection as the children were napping however the light was on and per licensee they are in operable condition at time of inspection. LPA observed First Aid kit kept at the entry to the facility and was inventoried for necessary supplies. Licensee provided proof of immunization against influenza, pertussis, and measles during today’s inspection. Licensee has current mandated reporter training with an expiration date of Sept 5, 2025.
—CPR Card valid until: 11/2024
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA did not observe any bodies of water around the premises at time of inspection. Per licensee, they provide food for children in care. Food preparation area was toured and found in compliance for safety, cleanliness, and proper storage.

LPA reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the licensee.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KIM FAMILY CHILD CARE
FACILITY NUMBER: 198010349
VISIT DATE: 06/04/2024
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The following were discussed:

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.

Licensee Jea Kim 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-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for 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. 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.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KIM FAMILY CHILD CARE
FACILITY NUMBER: 198010349
VISIT DATE: 06/04/2024
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During the exit interview, the Licensee Jea Kim confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on this information the following deficiencies on the LIC 809 D are being cited today 6/4/2024.

LPA Claudia Kam informed licensee Jea Kim that this report dated 6/4/2024 documents a Type B citation which poses a potential risk to the health, safety, or personal rights of children in care.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Jea Kim with translation assistance from employee Ellis Kim.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/04/2024 02:50 PM - It Cannot Be Edited


Created By: Claudia Kam On 06/04/2024 at 02:15 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: 06/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, provider interview, record review, the licensee did not comply with the section cited which poses a potential health, safety or personal rights risk to persons in care. Licensee does observe children during nap however no sleep log is kept for observation documentation
POC Due Date: 07/01/2024
Plan of Correction
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Licensee will complete a sleep log for the 2 infants in care and will submit a June log to LPA via email or text
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Denise Gibbs
LICENSING EVALUATOR NAME:Claudia Kam
LICENSING EVALUATOR SIGNATURE:
DATE: 06/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/04/2024


LIC809 (FAS) - (06/04)
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