198021172-5-20-2024-33-CC-SLEE-D5FUK2-20240520153822

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021172
Report Date: 05/17/2024
Date Signed: 05/20/2024 03:38:26 PM

Document Has Been Signed on 05/20/2024 03:38 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KOBAYASHI FAMILY CHILD CARE		FACILITY NUMBER:	198021172
ADMINISTRATOR/ DIRECTOR:	KOBAYASHI, MESEUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 774-8488
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90004
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 3	DATE:	05/17/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Meseun Kobayashi		TIME VISIT/ INSPECTION COMPLETED:	12:30 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) Seung Lee conducted an unannounced annual inspection. Upon arrival LPA Lee met with Licensee Meseun Kobayashi. Licensee was present with 3 children and her husband. Hours of operation are Monday-Friday 7AM-6PM. The large family child care home consists of 4 bedrooms, 3 restrooms, kitchen, backyard and living room. The off limits areas were the 2 bedrooms, and 1 bathroom, the kitchen, and backyard Children will be cared for in the living room, 2 bedrooms, 2 bathrooms. and parts of the frontyard. Adults living in the home are the Licensee and Licensee's spouse. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. There are age appropriate toys and napping equipment on the premises. Per Licensee there are no firearms or pets in the home. LPA Lee observed that the fire extinguisher was the appropriate size but there was no receipt or tag available to review. The two applicants CPR and first aide expires 01/2025. LPA observed a operational smoke and carbon monoxide detector located in the bedrooms that will be used for the day care. Fire extinguisher is located near the front entrance with a service tag date of 04/12/22. Licensee stated she will get the extinguisher serviced. This is a potential risk to children in care. LPA reviewed Sudden Infant Death Syndrome (SIDS), Shaken Baby Syndrome, and safe sleep practices with applicant. Infants should always sleep on their backs, mouths facing up, light bedding.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KOBAYASHI FAMILY CHILD CARE	FACILITY NUMBER: 198021172
	VISIT DATE: 05/17/2024

NARRATIVE

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The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting. LPA observed the mandated reporter training certificate for the licensee posted by the entrance of the facility.

A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.

Deficiencies cited on this inspection is attached on the 809D page.

Incidental Medical Services are not provided at this time. Licensee was informed to contact the department 30 days prior to enrolling any child with IMS needs.

LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov

The notice of site inspection must remain posted for 30 days during hours of operation. Failure to maintain posting for 30 days will result in a civil penalty of $100.00 dollars.

Exit interview conducted with Licensee Meseun Kobayashi. Appeal rights discussed and explained.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/20/2024 03:38 PM - It Cannot Be Edited

Created By: Seung Lee On 05/17/2024 at 01:45 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: KOBAYASHI FAMILY CHILD CARE	FACILITY NUMBER: 198021172
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations made during the inspection the licensee did not comply with the section cited above since the fire extinguisher was not served in the last year. which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/31/2024
	Plan of Correction
1 2 3 4	Licensee stated fire extinguisher will be serviced or replaced and proof will provided by POC date.

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:

Claudia Guangorena

LICENSING EVALUATOR NAME:

Seung Lee

LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC809 (FAS) - (06/04)

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