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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020716
Report Date: 05/26/2023
Date Signed: 05/26/2023 04:12:07 PM

Document Has Been Signed on 05/26/2023 04:12 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:HAPPY CAMPERS CHILDREN CENTERFACILITY NUMBER:
198020716
ADMINISTRATOR:YU-SHU (CINDY) CHENGFACILITY TYPE:
850
ADDRESS:14035 FRANCISQUITO AVETELEPHONE:
(562) 699-4991
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY: 76TOTAL ENROLLED CHILDREN: 20CENSUS: 14DATE:
05/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Director Yu Cheng (Jenny) TIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Roxana Lopez conducted a Case Management-Deficiencies visit on this date to address deficiencies revealed during a complaint investigation. A COVID risk assessment was conducted upon entry and appropriate Personal Protective Equipment (PPE) was used.

LPA initially arrived to the facility at 9:05 am for a complaint investigation and was denied entrance, due to Director not being present. LPA advised that the department has inspection authority and needed to be let in even if Director was not present. LPA entered facility at 9:27 am- took census and waited for Director to give a tour of facility. Director arrived at 10:00 am.

During walk through of outdoor play area LPA observed that staff # 1 and 2 with 14 children. LPA observed that Staff # 1 was not fingerprinted cleared and associated to facility. Records reviewed determined that Staff # 1 was listed under infant license but fingerprints are pending clearance.

Based on LPA observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) 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 and safety.

LPA Roxana Lopez informed facility representative Yu Cheng (Jenny) that this report dated 5/26/2023 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HAPPY CAMPERS CHILDREN CENTER
FACILITY NUMBER: 198020716
VISIT DATE: 05/26/2023
NARRATIVE
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Also, LPA Roxana Lopez informed the facility representative to provide a copy of this licensing report dated 5/26/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Exit interview conducted and report was reviewed with the facility representative Yu Cheng (Jenny).
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 05/26/2023 04:12 PM - It Cannot Be Edited


Created By: Roxana Lopez On 05/26/2023 at 02:42 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HAPPY CAMPERS CHILDREN CENTER
FACILITY NUMBER: 198020716

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/26/2023
Section Cited
CCR
101170(e)(1)

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101170(e)(1) All individuals subject to a criminal record review...shall prior to working...in a licensed facility:(1)Obtain a California clearance or a criminal record exemption as required by the Department
This requirement was not met as evidenced by:
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Per Director, Staff # 1 will go home and will not be at facility unti fingerprint cleared.
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Based on observation, interview and record review, Staff # 1 is pending fingerprint clearence, which poses an immediate health and safety risk to children 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/26/2023 04:12 PM - It Cannot Be Edited


Created By: Roxana Lopez On 05/26/2023 at 02:50 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HAPPY CAMPERS CHILDREN CENTER
FACILITY NUMBER: 198020716

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/02/2023
Section Cited
HSC
1596.852

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1596.852 Any duly authorized officer, employee, or agent of the department may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice to secure compliance...
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Per Director, they will have a meeting with all staff to inform them of regulation. A copy of meeting minutes and signatures will be submitted to the department by POC due date of 6/2/2023.
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This requirement is not met as evidenced by:
Based on observation, interview LPA was denied entry upon arrival. LPA was allowed in half hour after arriving, which poses a potential health and safety risk to children 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023


LIC809 (FAS) - (06/04)
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