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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314489
Report Date: 01/14/2025
Date Signed: 01/14/2025 11:54:08 AM

Document Has Been Signed on 01/14/2025 11:54 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SHIM, JUYEONFACILITY NUMBER:
304314489
ADMINISTRATOR/
DIRECTOR:		SHIM, JUYEONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 761-0063
CITY:IRVINESTATE: CAZIP CODE:
92602
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/14/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Applicant, Juyeon ShimTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Page One

On 1/14/2025, Licensing Program Analyst (LPA) Alma Castro conducted an announced, in-person Pre-Licensing inspection for a new Family Childcare home. The LPA met with applicant Juyeon Shim, who provided a tour of the home. There is 1 adult resident (applicant) who lives in the home. The adult resident(s) all received caregiver background check clearances or exemptions as required by the Department. Per the applicant, there are 1 minor child living in the home.

The phone translation service “Audio Interpreting Service” at the telephone number of 760-640-0562 was used during today’s annual inspection and the pin number of the translator was 279268 (Alex) – Language requested: Korean.

The applicant stated that she is not registered with any Resource Foster Care agency and that she does not hold a Resource foster parent license. The applicant was reminded to notify the licensing office of any changes.

The applicant is requesting a Large Family Childcare Home license. Per the applicant, operation hours will be Monday through Friday, 7:30 AM- 5:30 PM. Care and supervision will be provided to children ages 2 months to 12 years old. For the purposes of licensing, an infant is defined as any child 0 to 24 months of age.
SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Alma Castro
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHIM, JUYEON
FACILITY NUMBER: 304314489
VISIT DATE: 01/14/2025
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Page Two

All areas on the Facility Sketch LIC999 were inspected, including but not limited to, off-limits areas. The facility is a 2-story home with 4 bedrooms, 3 bathrooms, and a total of two living room(s), a kitchen, a laundry room, a front yard (not fenced), a backyard (fenced), and a garage. There is a fireplace located in the living room #1, currently barricaded with a baby gate that does not meet licensing requirements. There are stairs that lead to the 2nd floor. Applicant stated they understood stairs must be barricaded when children under (5) years old are present. Baby gate is securely installed at the foot of the stairs.

Based on the Facility Sketch LIC999 submitted, areas off-limits to children and parents are as follows: Applicant has designated the laundry room, garage, kitchen and entire second floor as the off-limits areas. The applicant has placed child-proof safety gates on both entrances to kitchen and leading up to the stairs. The applicant has a mesh baby gate that makes the garage inaccessible. Garage door is to remain locked during day care hours of operation.

Areas Designated for Day Care Activities: The applicant has designated living room one and two, guest bedroom (#1), guest bathroom, and backyard as designated day care areas.

Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation, and heating. The children’s bathroom was observed to be safe and free of hazardous items. The designated child care areas were observed to have age-appropriate toys.

Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children are inaccessible in areas designated for children. All drawers and cabinets in reach that have hazardous items have safety latches. The applicant stated that there are no poisons on the premises and LPA did not observe any. The applicant was advised that any poisons must be locked with a key or combination lock. The applicant stated that there are no weapons or firearms on the premises. The LPA informed the applicant that when firearms are present, they must be locked and stored separately from the ammunition per CCR 102417(g)(4)(C).
SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Alma Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHIM, JUYEON
FACILITY NUMBER: 304314489
VISIT DATE: 01/14/2025
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Page Three

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. The pressure gauge on the 2A-10BC fire extinguisher(s) indicates fully charged, as indicated on the service tag observed. Smoke and carbon monoxide detectors were tested and are operable. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

OUTDOOR PLAY AREA: Outdoor play activities will be conducted in the backyard. The backyard is appropriately fenced. LPA observed age-appropriate play equipment to be free from hazards. Applicant stated that there are no bodies of water on the premises. There is a non-working fountain the backyard that Applicant plans to add a foam surface or fill with sand.

The applicant stated she will provide food for the children. The applicant was informed that if children bring food from home, the children’s names must be labeled on their lunch bags and refrigerated/stored properly.

The licensee understands that there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

The applicant’s provided an email address during this inspection. The applicant was advised that the email address may be public information.

In the absence of the licensee, a qualified adult must be present to supervise children—a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification, TB clearance and immunization, and valid criminal record clearance that is associated with the licensed facility.

Annual fees must be paid by the due date, or a late fee shall be assessed and/or the License may be terminated.

The Child Advocacy Program was discussed with the applicant. The applicant was advised to register for the program to receive quarterly reports and other information in a timely manner. To register email ChildCareAdvocatesProgram@dss.ca.gov.
SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Alma Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHIM, JUYEON
FACILITY NUMBER: 304314489
VISIT DATE: 01/14/2025
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Reporting Requirements: Changes should be reported to the Department as soon as they occur, such as construction, remodeling, telephone number changes, and/or moving out from your home. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Applicant understands that the family childcare home must conduct a fire drill or a disaster drill at least once every six months. The licensee must document the date and time of each drill. This documentation must be kept at the facility for review by the Department.

No smoking, No Johnny jumpers, No saucer chairs: any other items that fall into that category are prohibited in the facility.

Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection authority, which includes but is not limited to the right to enter the house when children are being cared for, interview children and adults, and review documentation.

Applicant understands if they are licensed that they must post each facility license number in all advertisements, publications, or announcements with the intent to attract clients.

H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The applicant has submitted proof of immunizations.


Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors, and employees must complete training as specified on mandated reporter duties. Training is available at www.mandatedreporterca.com. The applicant has completed the required mandated reporter training. Recertification is required every two years.
SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Alma Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHIM, JUYEON
FACILITY NUMBER: 304314489
VISIT DATE: 01/14/2025
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Page Five

Incidental Medical Services Plan (IMS): The Incidental Medical Services (IMS) policy was discussed. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child. When IMS are provided, a Plan for Providing IMS must be submitted to the Department. For additional IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The applicant plans to store the medication in the kitchen, in a cabinet above the countertop, or in the refrigerator if needed.

The following information regarding (ADA) Americans with Disabilities Act was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

The Community Care Licensing Division (CCLD) regularly sends information to providers and stakeholders via Provider Information Notices (PIN), Program Quarterly Updates Newsletters, and other communication platforms. To subscribe for updates, visit https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe.

The LPA advised the applicant(s) on how to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov/inforesources/community-care-licensing. LPA reviewed and issued the LIC311D “Forms/Records to Keep in Your Family Child Care Home” and provided the forms below.

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by law to post the following: Facility License (LIC 203), Waivers (if applicable), Notification of Parent’s Rights Poster (PUB 394), Earthquake Preparedness Checklist (LIC 9148), Emergency Disaster Plan (LIC 610A) California Car Seat Law (PUB 269). A Notice of Site Visit (LIC 9213) must be posted for 30 days after each site inspection by a Licensing
SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Alma Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHIM, JUYEON
FACILITY NUMBER: 304314489
VISIT DATE: 01/14/2025
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Page Six

Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

The following was discussed with the applicant:
The licensee understands that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption prior to initial presence in a licensed facility. Violation of this requirement will result in a citation and civil penalties of one hundred dollars ($100) per violation, per day for a maximum of five (5) days for a first offense. Subsequent violations will result in civil penalties for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

Megan’s Law - Family Child Care Homes On this date, 01/14/2025 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

LPA discussed the safe sleep regulations with the applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed the applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Alma Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SHIM, JUYEON
FACILITY NUMBER: 304314489
VISIT DATE: 01/14/2025
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Page Seven

Fire clearance was given on this date 12/30/2024 and there are special conditions per usage. The garage is not approved for day care usage and the upstairs/2nd floor is not approved for day care use.

Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

The Large Family Child Care Home was not in compliance with Title 22 Regulations at the time of inspection. The applicant is required to submit the following corrections to the licensing office by the due date of 2/14/2025.

1. Crib or Pack’n’Play infant safe sleep
2. Fireplace Cover

In the event additional requirements are needed, the applicant will be notified. A license will be issued once all requirements are met.

Appeal rights were provided, and an Exit Interview was conducted with applicant Juyeon Shim.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection, its tools, and methods, please visit the Program Website
at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.


SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Alma Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
Page: 7 of 7