<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400479
Report Date: 06/22/2023
Date Signed: 06/22/2023 12:40:10 PM

Document Has Been Signed on 06/22/2023 12:40 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CHAN FAMILY CHILD CAREFACILITY NUMBER:
198400479
ADMINISTRATOR:CELEST CHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 610-2584
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
06/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Karen Munoz, Licensee's AssistantTIME COMPLETED:
01:00 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
On 06/22/2023 at 11:25 AM, Licensing Program Analyst (LPA) Katrina Chicote conducted an Unannounced-Case Management inspection to follow up on several incidents that was reported to The Department. Upon arrival, LPA disclosed the purpose of inspection with Karen Munoz, Licensee's Assistant, who allowed entry to facility. Assistant states that Licensee had just left to run some errands. LPA observed 11 children, three of which are infants, and an additional Assistant present during today's inspection. LPA observed all adults present in the home have criminal record clearance at time of inspection.

On 03/14/2023, an unusual incident was anonymously reported The Department via online complaint hotline regarding an incident with the neighbors and concerns alleging supervision, capacity, and personal rights of the children at the facility.



On 06/14/2023, additional incident was reported anonymously to The Department via online complaint hotline regarding an incident that involved a neighbor breaking Licensee's car window. Additional information was again provided expressing concerns alleging supervision, capacity, and personal rights of the children at the facility.

LPA conducted interviews at time of inspection. Corroborating information was provided of an incident in regards to the neighbor causing disturbance to the facility outside of operating hours. Interview with Licensee's Assistant states that neighbor broke Licensee's car window and throws items such as small metal pieces over at the facility. Licensee interview states these items are thrown on front lawn only.

Unusual incidents described in reports were not reported to The Department by Licensee within 24 hours of incidents and no written report received within seven days of incidents. LPA notified Licensee of requirement to report unusual incidents to The Department by calling main line and reporting to On Duty worker or submitting via email at MPSWIncidentReports@dss.ca.gov using the LIC 624B). LPA provided technical support on reporting requirements.
Report Continues - Page 1 of 2
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CHAN FAMILY CHILD CARE
FACILITY NUMBER: 198400479
VISIT DATE: 06/22/2023
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 facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today but advisories were given.

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

Exit interview was conducted and report was reviewed with the Facility Representative, Karen Munoz.


Report Ends - Page 2 of 2
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2