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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495523
Report Date: 05/29/2025
Date Signed: 05/29/2025 12:19:41 PM

Document Has Been Signed on 05/29/2025 12:19 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:KIM FAMILY CHILD CAREFACILITY NUMBER:
197495523
ADMINISTRATOR/
DIRECTOR:		NARA KIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 505-0600
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/29/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Nara Kim, James KimTIME VISIT/
INSPECTION COMPLETED:
12:18 PM
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On 5/29/2025 at 9:15am, Licensing Program Analyst (LPA) Devon Carus conducted a pre-licensing inspection with applicant Nara Kim. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes.

Applicant is applying for a Large Family Child Care License with a maximum capacity of 14.

Per the application, at this time, the ages the applicant wishes to provide services for are children 2 years old to entry into first grade, Monday-Friday from 8:30 am to 5:30 pm. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes. Applicant will not be providing transportation regarding pickups or drop offs to or from any location.



LPAs toured the home inside and outside. The facility is a one story house consisting of 4 bedrooms, 4 bathrooms, a living room, kitchen/dining area, back yard, front yard, and garage. There is a pool on the premises with an installed pool alarm, 12 foot pool hook, 18 inch diameter life preserver ring, log for pool equipment updates, and a fence that is at least 5 feet tall with an outward swinging, self latching gate making the entire pool inaccessible to children. Applicant confirmed that there is one dog on the premises that will not be residing in areas where the daycare children will be. The back yard, and bathroom #4, and bedroom #4 will be used for the daycare. Bedrooms #1-3, bathrooms #1-3, kitchen, dining room, and front yard will be OFF-LIMITS.

Parents will access the home through the side gate. Once you enter the gate, you will enter the back yard/ outdoor daycare area. To the left is the Bedroom #4 which is the main daycare area. Additionally, there is Bathroom #4 which is also used for the daycare. If you walk to the right and straight out of the daycare area, there is a dining area and kitchen blocked by a child safety gate. Immediately to the right of this is the door leading to the outdoor daycare area which is completely enclosed by a large fence and hedges. If you continue into the kitchen outside of the child accessible area, there will be the dining room on your right, and living room to your left. If you continue through the living room, there will be bedrooms #1-3, and restrooms #1-3 in front of you and to the left. LPA inspected the entire day care area and observed it to be clean, and orderly. LPAs inspected the bedrooms #1, #2, and #3 and observed them to be clean and orderly. LPAs inspected the day care areas and observed age-appropriate toys and materials. Applicant confirmed children will nap in indoor daycare area located in Bedroom #4 (approximately 20’x33.5’) . Bedroom #2 will be used as an isolation area for ill children. The children will eat at children’s table set up as a part of the indoor section of the daycare in Bedroom #4.

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Devon Carus
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: KIM FAMILY CHILD CARE
FACILITY NUMBER: 197495523
VISIT DATE: 05/29/2025
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Fire and safety drills must be performed every six months and documented for review by the Department.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

LPA advised the applicant how to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Devon Carus
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: KIM FAMILY CHILD CARE
FACILITY NUMBER: 197495523
VISIT DATE: 05/29/2025
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Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation.

Applicant was made aware that state law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.

Applicant was also informed that the provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

A current roster of children (LIC 9040) enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.

Changes should be reported to the Department as soon as they occur such as construction and remodeling, telephone number changes and/or if you move from home.

Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference.

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Devon Carus
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: KIM FAMILY CHILD CARE
FACILITY NUMBER: 197495523
VISIT DATE: 05/29/2025
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On this date, 11/28/2024, 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.

Applicant(s) were informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541. Email Address: childcareadvocatesprogram@dss.ca.gov

Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis, and measles. LPA discussed the influenza waiver during the inspection.

Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.

Applicant(s) were reminded that it is the applicants, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Devon Carus
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: KIM FAMILY CHILD CARE
FACILITY NUMBER: 197495523
VISIT DATE: 05/29/2025
NARRATIVE
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(0) corrections were needed during today’s inspection.

Exit interview was conducted with applicant Nara Kim.

Applicants were reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed with applicant(s) the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. PIN 22-05-CCP Page Eight

LPA discussed the safe sleep regulations with applicant(s) 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. LPA also informed [applicant, licensee, or facility representative] 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.

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Devon Carus
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: KIM FAMILY CHILD CARE
FACILITY NUMBER: 197495523
VISIT DATE: 05/29/2025
NARRATIVE
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Next to the daycare space, bathroom #4 was observed. Children will use bathroom #4 during day care hours. A functioning toilet and sink were observed. LPA observed bathroom drawers. There was adequate hand soap, and paper towels in the drawers.

Kitchen was observed and inspected. This entire area is inaccessible to children by way of children’s safety gate Cabinet under the sink holds the cleaning supplies, and a working fire extinguisher (model 3A-40BC) . Refrigerator, stove, and counter space were observed and inspected. LPA observed a high shelf in Bedroom #4 where the first aid kit resides. LPA observed the kit with gauze, Band-Aids, thermometer, and an Ice Pack.

Knives and sharp objects were observed in a kitchen drawer that is inaccessible to children in care. LPA also observed a children’s safety gate making toxins inaccessible to children in care. Applicant plans to provide snacks and meals for children in care. LPA discussed the importance of having policies in place to ensure that all who potentially help with care and supervision are aware of any dietary restrictions and/or allergies. LPA also encouraged applicant to contact their local Resource and Referral agency to inquire about any food programs & resources should they want to change their meal plan.

Applicant stated that there are no firearms or weapons on the premises.

Applicant and LPA tested carbon monoxide, and smoke detectors that are in working order. LPA observed all electrical outlets in the home covered.

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Devon Carus
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC809 (FAS) - (06/04)
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