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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409311
Report Date: 09/19/2024
Date Signed: 09/19/2024 01:15:50 PM

Document Has Been Signed on 09/19/2024 01:15 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PARK, MIKYONGFACILITY NUMBER:
434409311
ADMINISTRATOR/
DIRECTOR:		PARK, MIKYONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 873-1685
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
09/19/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:53 PM
MET WITH:Mikyong ParkTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Plan of Correction (POC) inspection. LPA met with Licensee Mikyong Park and explained the reason for the inspection. The purpose of this inspection is Licensee was cited on 09/05/2024 for not documenting the time napping infants are checked and for a child sleeping in a car seat. Present during today's inspection were Licensee and five children, whom one was infant age.

During today's inspection, LPA conducted observation and reviewed sleep check log. LPA observed that all children were sleeping on mats and there was no children asleep in the car seat. LPA obtained written statement and plan on where infant will be sleeping and that they will not sleep in the car seat.

LPA reviewed sleep check log. LPA discussed with Licensee that she is required to document the date, name of the infant, and time of each 15 minute check.

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Licensee Mikyong Park. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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