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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417288
Report Date: 03/14/2024
Date Signed: 03/14/2024 01:09:05 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/05/2024 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240305133850
FACILITY NAME:SONG, JISOOFACILITY NUMBER:
434417288
ADMINISTRATOR:SONG, JISOOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 710-6765
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:14CENSUS: 8DATE:
03/14/2024
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Jisoo Song TIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Daycare owner is running two daycare facilities at the same time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation for the above allegation. Upon arrival, LPA was greeted by Assistants, Kyung Ju Seo and Dongyoun Kim. Licensee Jisoo Song and her spouse, who helped translate, arrived shortly after.

During the course of this investigation, LPA inspected the physical plant. LPA also interviewed Licensee and assistant. LPA also reviewed staff and children's files. Based on the information obtained, the above allegation is found to be SUBSTANTIATED, meaning the preponderance standard has been met.
-------------------CONTINUES ON 809 DATED 03/14/2024---------------------
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
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 4
Control Number 07-CC-20240305133850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SONG, JISOO
FACILITY NUMBER: 434417288
VISIT DATE: 03/14/2024
NARRATIVE
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-----------CONTINUATION OF 9099 DATED 03/14/2024 PAGE 1---------------

Based on record reviews, there is a signed agreement between parents, Joyful Christian Preschool, and Sookkyoung Kim. Sookkyoung Kim is a licensee of another Family Child Care Home (FCCH). Licensee also stated that checks are made out to Sookkyoung Kim. Licensee understands that Licensee can only run one Family Child Care Home. Per Section 102352: Definition, it states that Family Child care means regularly provided care, protection and supervision of children, in the care giver's own home.

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Licensee Jisoo Song. 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: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20240305133850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SONG, JISOO
FACILITY NUMBER: 434417288
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2024
Section Cited
CCR
1596.78(a)
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“Family day care home." "Family day care home" means a home that regularly provides care, protection, and supervision for 14 or fewer children, in the provider's own home...
This requirement is not met as evidenced by:
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By 03/21/2024, Licensee will submit written statement that Sookkyoung Kim is not running both FCCH.
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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: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4