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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009915
Report Date: 03/11/2022
Date Signed: 03/11/2022 12:05:58 PM

Document Has Been Signed on 03/11/2022 12:05 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PARK FAMILY CHILD CAREFACILITY NUMBER:
198009915
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
03/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jae Park TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced required inspection. Upon arrival LPA Lee met with Licensee Jae Park. The following was observed.

Adults living in the home are the Licensee and Licensee's spouse. Hours of operation are Monday-Friday 8AM-4:30PM. All areas identified on the facility sketch were inspected. This is a two story home which consists of 3 bedrooms, 3 restrooms, kitchen, living room, kitchen, and balcony. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The home has air conditioning throughout the house.

Areas off limits include: All of upstairs which includes 3 bedrooms, and 2 restrooms and kitchen on the first floor. Areas used by children include: Living room, 1 bathroom, and balcony on the first floor. A gate was observed by the stairs leading to the second floor.

During the inspection, LPA observed that CPR for licensee expire on 01/2022. Operational smoke and Carbon monoxide detector were observed in the off limits kitchen on the first floor. Fire extinguisher was last serviced on 03/19/2021 per service tag. LPA observed a drill log for emergency drills conducted. Last drill was conducted on 03/2022 per log.

During the inspection LPAs advised the licensee to comply with the latest guidelines from the California department of Health regarding health and sanitation practices for family child care homes. Licensee was advised to visit the department website for updates.
SUPERVISORS NAME: Guangorena Claudia
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PARK FAMILY CHILD CARE
FACILITY NUMBER: 198009915
VISIT DATE: 03/11/2022
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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)/ (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 advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

There were no deficiencies observed during the inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Jae Park. .
SUPERVISORS NAME: Guangorena Claudia
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC809 (FAS) - (06/04)
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