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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313570
Report Date: 09/22/2022
Date Signed: 09/22/2022 01:01:29 PM

Unsubstantiated


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
09/06/2022 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20220906144747
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: 4DATE:
09/22/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Im Kyoung Oh, LicenseeTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Day care child sustained injuries while in care due to lack of supervision.
Licensee hit day care child.
INVESTIGATION FINDINGS:
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On 09/22/2022, Licensing Program Analyst (LPA) Tran and LPA Duron conducted a subsequent investigation and to deliver the finding regarding the above complaint allegations. LPAs Tran and Duron met with Licensee and informed her of the allegations. Observed at the time of the visit was a total of 4 children including 2 infants and 2 staff members. A review of staff criminal clearance records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 09/06/2022, the Department received a complaint alleging day care child sustained injuries while in care due to lack of supervision, and licensee hit day care child. Reporting Party (RP) stated that subject child had sustained injuries while being in care due to lack of supervision. RP stated that subject child, Child#1 (C1) told RP that C1 was hit by the Licensee on the face.
(Continue next page)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
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
09/06/2022 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20220906144747

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: 4DATE:
09/22/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Im Kyoung Oh, LicenseeTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Licensee did not notify day care child's parent of injuries.
INVESTIGATION FINDINGS:
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On 09/22/2022, Licensing Program Analyst (LPA) Tran and LPA Duron conducted a subsequent investigation and to deliver the finding regarding the above complaint allegation. LPAs Tran and Duron met with Licensee and inform Licensee of the allegations. Observed at the time of the visit was a total of 4 children including 2 infants and 2 staff members. A review of staff criminal clearance records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 09/06/2022, the Department received a complaint alleging Licensee did not notify day care child's parent of injuries.
On 09/12/2022, LPA Tran conducted the 10-days initial investigation at the facility and obtained facility's staff and children roster, facility’s Operational Policy and Letter of Agreement for review and interviewed 3 staff members.
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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 06-CC-20220906144747
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: 09/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2022
Section Cited
CCR
102416.2(f)(1)
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102416.2 Reporting Requirements
(f) As soon as possible...the licensee shall notify a child's parent (1) Any injury suffered by a child in care...regardless of treatment by a medical professional.

This requirement is not met evidenced by:
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Licensee stated Licensee will submit a statement of understanding the regulation and a plan to document parent's notification in regards to child's incident, to LPA Tran via email by due date.
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Base on observation, interviews, and record review, Licensee failed to provide documentation of child's injury notification to child's representative.
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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: 09/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 06-CC-20220906144747
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: 09/22/2022
NARRATIVE
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(Page 2 of Report)

During interviews, when asked about notification for parents if and when any child was injured in care, all 3 interviewed staff said that Licensee will notify parents via a phone call or a text message.

On 09/22/2022, LPA Tran and LPA Duron conducted an subsequent investigation at the day care. C1's file was reviewed. There was no documentation of injury report in C1's file. When interviewed, Licensee could not provide any documentation in regarding C1's injuries while C1 was in care. Licensee stated Licensee communicated to parents regarding C1's injury but failed to provide any written document.

Based on the information gathered from LPAs' interviews with Licensee and assistant on 09/12/22 and with Licensee on 09/22/22, record review of child's file, the preponderance of evidence standard has been met, therefore the above allegation Licensee did not notify day care child's parent of injuries, is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 & Chapter 1, Section 102416.2 (f)(1) Reporting Requirement, is being cited on the attached LIC 9099 D.

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) and their signature on this form acknowledges receipt of these rights.” This report LIC 9099 was provided to the Licensee. First level appeal is to Regional Manager, address is above on the report.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 06-CC-20220906144747
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: 09/22/2022
NARRATIVE
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(Page 2 of Report)

On 09/12/2022, LPA Tran attempted to interview C1, but was not able to due not able to obtain parent's permission.

On 09/12/2022, LPA Tran conducted the 10-days initial investigation at the facility and obtained facility's staff's and children roster, facility’s Operational Policy and Letter of Agreement for review and interviewed 3 staff members.

During the staff interviews, all 3 interviewed staff gave consistent answers regarding facility's discipline policy including talking to child, giving warnings, time-out and inform parents as needed. All 3 out of 3 interviewed staff denied that they have ever hit a child or witnessed any staff hit a child. They all stated that the children were always being supervised in all activities. Licensee and assistant will take turn to take a break, while the other staff supervise the children.

LPA Tran attempted to interview the children in care but was not able to due the age range of the children in care, were from 18 months to 3 years of age.

During record review, the Operational Policy and Letter of Agreement, stated the discipline policy, which include talking to child, giving warnings, time-out and inform parents as needed.

Based on the information gathered from LPA's interviews with Licensee and assistants on 09/12/22 and reviewing records of facility's Operational Policy and Letter of Agreement, there is insufficient evidence to corroborate the allegations that day care child sustained injuries while in care due to lack of supervision and
licensee hit day care child. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that day care child sustained injuries while in care due to lack of supervision and licensee hit day care child, did or did not occur, therefore the allegations day care child sustained injuries while in care due to lack of supervision and licensee hit day care child, are UNSUBSTANTIATED.

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

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 06-CC-20220906144747
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: 09/22/2022
NARRATIVE
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(Page 3 of Report)

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) and their signature on this form acknowledges receipt of these rights.” This report LIC 9099 was provided to the Licensee. First level appeal is to Regional Manager, address is above on the report.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6