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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019905
Report Date: 06/29/2021
Date Signed: 06/29/2021 09:30:26 AM

Document Has Been Signed on 06/29/2021 09:30 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:KWON FAMILY CHILD CAREFACILITY NUMBER:
198019905
ADMINISTRATOR:JI KWONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 507-6655
CITY:LOS ANGELESSTATE: CAZIP CODE:
90057
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
06/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ji Kwon TIME COMPLETED:
09:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced Required 1 Year inspection. LPA met with licensee, Ji Kwon, who guided analyst on a tour of the facility at approximately 8:35 AM. The licensee's assistant, So Kim, was also present. The Licensee's 2 teenage daughters were present in the home. The Licensee is Korean speaking. There were 9 children present. Licensee states that there are currently 14 children enrolled.

All areas identified on the facility sketch were inspected. This is a one story home which consists of 3 bedrooms, 2 restrooms, kitchen, living room, dining room, backyard (fenced) and front yard. Areas off limits include: 3 bedrooms, 1 bathroom, kitchen, and garage in the backyard. Areas used by children include: Living room, dining room, 1 bahtroom, and backyard.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating (central air/heating) for safety and comfort. There were safe toys, play equipment and materials observed for children. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in some areas of the home (see 809d). LPA observed that the cabinet under the bathroom sink does not have a latch, making a bottle of Clorox spray accessible to children; this poses an immediate risk to the health and safety of children in care. The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock.

Per Licensee she does not care for infants.

LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was explained and issued to the Licensee. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained.

*REPORT CONTINUES ON THE NEXT PAGE
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: KWON FAMILY CHILD CARE
FACILITY NUMBER: 198019905
VISIT DATE: 06/29/2021
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Per licensee, there are no weapons, firearms or bodies of water on the premises. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged (purchased 05/29/20), however, it has not been serviced yearly as required; this is a potential risk to the health and safety of children in care. Smoke detector and carbon monoxide detector were tested and are in operable condition. The licensee has current Pediatric First Aid and CPR, which will expire 07/2022.

Incidental Medical Services (IMS) policy was discussed. Per Licensee, there are no children on medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee. Licensee and her assistant have immunization records on file.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers Licensee completed training on 09/23/2019.




*REPORT CONTINUES ON NEXT PAGE
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
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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: KWON FAMILY CHILD CARE
FACILITY NUMBER: 198019905
VISIT DATE: 06/29/2021
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The following was discussed:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided.
· Car seats shall only be used for transportation purposes and shall not be used for sleeping.
· All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined.

The licensee’s email address was obtained during this visit. The licensee was advised that email is public information.

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

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
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Document Has Been Signed on 06/29/2021 09:30 AM - It Cannot Be Edited


Created By: Judy Mora On 06/29/2021 at 08:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KWON FAMILY CHILD CARE
FACILITY NUMBER: 198019905

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/30/2021
Section Cited
CCR
102417g(4)

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Operation of a Family Child Care Home The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where
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Licensee states she will instgall a latch on the cabinet and submit proof to LPA by 06/30/21.
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they are inaccessible to children.
This requirement was not met as evidenced by
LPA observed that the cabinet under the bathroom sink does not have a latch, making a bottle of Clorox spray accessible to children; this poses an immediate risk to the health and safety of children in care.
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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.
SUPERVISOR'S NAME:Claudia Guangorena
LICENSING EVALUATOR NAME:Judy Mora
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2021


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Document Has Been Signed on 06/29/2021 09:30 AM - It Cannot Be Edited


Created By: Judy Mora On 06/29/2021 at 09:02 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KWON FAMILY CHILD CARE
FACILITY NUMBER: 198019905

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/09/2021
Section Cited
CCR
102417g(1)

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Operation of a Family Child Care Home The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector
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The Licensee states she will have fire extinguisher serviced and submit proof of service to LPA by 07/09/2021.
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device which meet standards established by the State Fire Marshal.
The valve on the required 2A 10BC fire extinguisher indicates fully charged (purchased 05/29/20), however, it has not been serviced yearly as required; this is a potential risk to the health and safety of children in care.
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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.
SUPERVISOR'S NAME:Claudia Guangorena
LICENSING EVALUATOR NAME:Judy Mora
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2021


LIC809 (FAS) - (06/04)
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