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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021513
Report Date: 10/15/2024
Date Signed: 10/16/2024 01:26:35 PM

Document Has Been Signed on 10/16/2024 01:26 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GREEN GRIN CHILDCARE CENTERFACILITY NUMBER:
198021513
ADMINISTRATOR/
DIRECTOR:		HAE JIN K LEEFACILITY TYPE:
860
ADDRESS:211 S PACIFIC AVETELEPHONE:
(818) 242-4492
CITY:GLENDALESTATE: CAZIP CODE:
91204
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 19DATE:
10/15/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Hae Jin K Lee TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 10/15/2024 at 10:05 am, Licensing Program Analyst (LPA), Crystal Green conducted an announced Pre-Licensing inspection for a Change of Ownership. Upon arrival, LPA met with Applicant Representative Hae Jin K Lee. The facility is currently licensed as Growing Years Children Academy (198018702), with a capacity of 30 preschool children from ages 2 until entry into first grade in classrooms 1, 2, and the Resource Room. Applicant, Green Grin Childcare Center, Inc., has requested to be licensed for 30 preschoolers ages 2 to 5 years old in classrooms 1, 2, and the Resource Room. Hours of operation will be Monday to Friday from 8:00 am to 5:00 pm.

This facility is located on the premises of Grace Korean United Methodist Church. The entrance to the facility is via the gate entrance facing the parking lot. Present during today’s inspection were (19) children with (4) staff. Appropriate ratios and supervision were observed. All indoor and outdoor activity space utilized for the children was inspected today.

LPA informed applicant representative that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, applicant representative stated that they will be stored in a secured location within the Director’s Office. A fully equipped first aid kit is also located in the Director’s Office. There is an operational carbon monoxide detector on site located near the kitchen area. All required licensing documents were observed posted outside of the Director’s Office. Children will also be signed in and out outside of the Director’s Office.

LPA continued to tour the facility and measured all indoor and outdoor activity space. The total indoor activity space measured was 1,687.33 square footage, which can accommodate the requested capacity. LPA observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, napping cots, bookshelves, and other activity supplies for the children.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GREEN GRIN CHILDCARE CENTER
FACILITY NUMBER: 198021513
VISIT DATE: 10/15/2024
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Drinking water will be available to children via a filtered water dispenser with each child’s personal water bottle. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Fire clearance was granted on 06/21/2024 by the Glendale Fire Prevention Department.

LPA observed a total of 4 sinks and 2 toilets available for children’s use. These are sufficient to accommodate the requested capacity of children. There is a separate staff restroom equipped with a toilet and a sink located near the Resource Room. The isolation area for children who are ill will be located in the Director’s office area. The ill children will use the staff restroom.

The facility will provide AM/PM snacks and lunch. There is a full kitchen located on the premises next to the Resource Room. The kitchen area includes a refrigerator, sink, stove, microwave, and food prep countertop. The kitchen prep area was observed to be free of hazards. The kitchen and food storage areas were observed free of rodents and/or vermin.

The facility currently has a fully fenced playground area. The fencing surrounding the playground area is made of wrought iron fencing which was observed to be at least four feet high. LPA obtained measurements of the designated area which calculated to be 2,641.37 square footage, which can accommodate the requested capacity. There are sufficient outdoor age-appropriate toys and play equipment available within playground area. There is adequate cushioning in fall zones of climber provider via rubber mats. Drinking water will be available via filter water with personal water bottles. LPA observed all hazardous items on the playground to be inaccessible to children. Applicant Representative was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).
Applicant representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides 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
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GREEN GRIN CHILDCARE CENTER
FACILITY NUMBER: 198021513
VISIT DATE: 10/15/2024
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exemption, prior to initial presence in a Child Care Center. 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, an updated Plan of Operation that includes 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

Applicant Representative was 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.

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 platforms. 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 communications.

No corrections are needed. A license for (30) children from ages 2 to 5 years old in classrooms 1, 2, and the Resource Room will be granted upon a final file review.

Exit interview conducted and report was reviewed with the Applicant Representative, Hae Jin K Lee.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
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