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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313570
Report Date: 09/15/2022
Date Signed: 09/22/2022 12:51:58 PM

Document Has Been Signed on 09/22/2022 12:51 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
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: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
09/15/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Im Kyoung Oh, LicenseeTIME COMPLETED:
01:00 PM
NARRATIVE
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*** This is an amended report to correct the information on the LIC 809D ***

A unannounced inspection was conducted at the facility by Licensing Program Analyst (LPA) Tran and LPA Castanon. LPAs observed licensee caring for 6 children including 3 infants. Licensee was operating within the licensed capacity and met staff-child ratio as specified on license.
On 09/12/2022, LPA Tran cited a type A violation due to Licensee was operating over the capacity, caring for 7 infants without assistant. On 09/12/2022, Licensee dismissed four children including child #1 (C1) and submitted a written statement about the 4 children, including child #1, were no longer attending the day care.
During today's inspection, LPAs observed child #1 was attending the day care. When interviewed, Licensee informed LPA that she accepted child #1 back into care on 09/14/2022 due to one of the other infants, Child #2, was dis-enrolled by the parents as of the 09/13/2022. LPAs Tran and Castanon, interviewed the parents of the C1 and C2 and verified that Licensee's statement was true. Licensee also submitted an updated Children Roster and it was updated that C2 was dis-enrolled on 09/13/22 and C1 was re-enrolled as of 09/14/22.
Based on LPAs' observations, record reviews and interviews, Licensee has complied as stated in the plan of correction regarding operating within capacity and meeting staff-child ratio. The Type A Deficiencies which were cited on 09/12/2022 was cleared by visit.
During today inspection, it was discovered that Licensee hired a new assistant, Ms Hyunjung Kim, who arrived at the facility at approximately 8:45am. Licensee introduced Ms. Kim to LPAs that this was her new assistant, who had started to work on 09/13/2022. A review of the Facility Personnel Report Summary on this date indicates that Ms. Hyunjung Kim, did not receive criminal background clearance checks. When interviewed, Ms. Hyunjung Kim, stated that she was hired and worked here at the facility on 09/13/2022 and on 09/14/2022. Ms. Kim was advised to leave the facility immediately due to the criminal record clearances has not been received.
(Continue next page)
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.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/15/2022
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(Page 2 of Report)

*** This is the amended report to correct the LIC 809D ***

Based on LPAs' observations, record reviews and interviews, the following violation was observed, in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 102370(d)(1) Criminal Record Clearance, is being cited on the attached LIC 809D.

An immediate civil penalty of $300.00 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 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: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document is an Amendment of Original Document on 09/22/2022 08:36 AM


Created By: Nguyen K Tran On 09/15/2022 at 10:35 AM
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
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: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/15/2022
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance - All individuals subject to a criminal record review...(d) all 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 Kim both admit that staff Kim has started to work for 3 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.
SUPERVISOR'S 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


LIC809 (FAS) - (06/04)
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