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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313570
Report Date: 02/23/2022
Date Signed: 02/23/2022 03:48:05 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2022 and conducted by Evaluator Nguyen K Tran
COMPLAINT CONTROL NUMBER: 06-CC-20220222084225
FACILITY NAME:OH, IM KYOUNGFACILITY NUMBER:
304313570
ADMINISTRATOR:OH, IM KYOUNGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(657) 239-0849
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:14CENSUS: 12DATE:
02/23/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Im Kyoung Oh, LicenseeTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Unqualified staff providing care.
INVESTIGATION FINDINGS:
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On 02/23/2022 at 11:30AM, Licensing Program Analyst (LPA) Nguyen Tran conducted an initial 10-day complaint investigation. Upon arrival, LPA met with Licensee Im Kyoung Oh and toured the facility. Census was observed as following: 12 preschool children with 2 staffs. LPA informed Licensee about the allegations.
A review of staff records on this date indicated that one facility staff, Bianca Esquivel, who required caregiver background checks have not received criminal record and child abuse index clearance or exemption.
LPA Tran also interviewed Licensee and Bianca Esquivel. Both Licensee and Ms. Esquivel, confirmed that Bianca Esquivel did not receive criminal record and child abuse index clearance or exemption, and that Ms Esquivel has stared to work from 02/15/2022 until today 02/23/2022, for a total of 7 working days.
Based on LPA's observation, record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation unqualified staff providing care is found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 12 chapter 1, Section 102370 (d) Criminal Record Clearance is being cited on the attached LIC 9099D.
(Continue next page)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2022 and conducted by Evaluator Nguyen K Tran
COMPLAINT CONTROL NUMBER: 06-CC-20220222084225

FACILITY NAME:OH, IM KYOUNGFACILITY NUMBER:
304313570
ADMINISTRATOR:OH, IM KYOUNGFACILITY TYPE:
810
ADDRESS:8402 SUNNYBROOK AVETELEPHONE:
(657) 239-0849
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:14CENSUS: 12DATE:
02/23/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Im Kyoung Oh, LicenseeTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Food Service
Physical Plant.
INVESTIGATION FINDINGS:
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On 02/23/2022 at 11:30AM, Licensing Program Analyst (LPA) Nguyen Tran conducted an initial 10-day complaint inspection. Upon arrival, LPA met with Licensee Im Kyoung Oh and toured the facility. Census was observed as following: 12 preschool with 2 staffs. LPA informed Licensee about the allegations.

During the investigation, LPA Tran observed Licensee served whole milk for the children in care. The milk was checked and expiration date is 03/01/22. When interviewed, Licensee admitted that she did not know that she should be serving 1% milk for the children in care.
During inspecting the outdoor areas, LPA and Licensee observed broken wooden pieces with nails sticking out from the wood, in the grass area. LPA and Licensee also observed broken tiles on the patio area. When interviewed, Licensee said she was going to clean them up but forgot to do so. Also, Licensee confirmed that this outdoor area was being used this morning for the children's outdoor activity.

(Continue next page)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 06-CC-20220222084225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OH, IM KYOUNG
FACILITY NUMBER: 304313570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/23/2022
Section Cited
HSC
1596.808 (a)(1)
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1596.808 Beverages served by day care providers to children (a) Commencing January 1, 2012....a licensed child day care facility shall comply...for beverages served by the day care provider to children in the provider’s care: (1)...serve only lowfat (1 percent) milk or nonfat milk to children two years of age or older
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Licensee will submit to LPA written statement of understanding of the regulation regarding beverage served by day care providers to children and will comply with the Health and Safety Code, by 03/09/2022.
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This requirment is not met evidenced by:
Base on observation and interview, Licensee admitted that she served whole milk to the children in care, which poses a potential risk to the health of the children in care.
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Type B
02/23/2022
Section Cited
CCR
102417(g)
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102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child.

This requirement is not met evidenced by:
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Licensee will fix the broken tiles in the patio area and will remove the broken wooden pieces from the outdoor activity area, and will provide a picture proof for LPA by 03/09/2022.
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Base on observation and interview, Licensee acknowledged that there were broken tiles and broken wooden pieces in the outdoor play areas, which poses potential risks to the health and safety of 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.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 06-CC-20220222084225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OH, IM KYOUNG
FACILITY NUMBER: 304313570
VISIT DATE: 02/23/2022
NARRATIVE
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(Page 2 of Report)

Based on LPA's observation and interview, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Health and Safety Code Chapter 3.4, Article 2, Section 1596808 (a)(1) and Code of Regulations, Title 22 Division 12 chapter 1, Section 102417 (g) are being cited on the attached LIC 9099D.

Exit interview was conducted. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. “The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights.” This report LIC 9099 was provided to Licensee Oh. First level appeal is to Regional Manager, address is above on the report.

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 06-CC-20220222084225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OH, IM KYOUNG
FACILITY NUMBER: 304313570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2022
Section Cited
CCR
102370(d)
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102370 Criminal Record Clearance - 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 is not met evidenced by:
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Licensee stated that the person is no longer working for her. She agreed to not allow personnel to work for her unless clearances are submitted and cleared. She will submit a written correction to LPA on how she will comply.
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Base on observation, interview and record review, Licensee and staff Bianca both admit that staff Bianca has started to work for 7 days without receiving criminal record and child abuse index, this posts an immediate risk to the health and safety of the 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.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 06-CC-20220222084225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OH, IM KYOUNG
FACILITY NUMBER: 304313570
VISIT DATE: 02/23/2022
NARRATIVE
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(Page 2 of Report)

An immediate civil penalty of $500.00 was assessed today for Caregiver Background Check.

If the facility receives a Type 'A' violation the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days. The licensee is to keep Acknowledgement Receipt (LIC9224) signed by parents in each child’s file.

Exit interview was conducted. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. “The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights.” This report LIC 9099 was provided to Licensee Oh. First level appeal is to Regional Manager, address is above on the report.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6