Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312418
Report Date: 09/14/2015 12:00:00 AM
Date Signed 09/14/2015 12:42:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LEE, HEASOOKFACILITY NUMBER:
304312418
ADMINISTRATOR:LEE, HEASOOKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 768-6756
CITY:ANAHEIMSTATE: CAZIP CODE:
92808
CAPACITY:14CENSUS: 7DATE:
09/14/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Heasook Lee-LicenseeTIME COMPLETED:
01:00 PM
NARRATIVE
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LPA Andrea Taylor met with licensee, Heasook Lee, for a annual random visit in accordance to Title 22. LPA toured areas of the home inside and outside and areas accessible to the children. The census includes ,7 daycare children with ages ranging from 7 months to 4 years old. (3 infants, 4 toddlers and no school-age children). A review of family member/staff records on this date indicates that all family members and/or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions except for assistant Linda Menefee. Licensee was able to show proof of CPR (exp: 8/16/16) and First Aid (exp: 8/16/16) that is EMSA certified. LPA observed posted Parent's Rights and current disaster plan. LPA also reviewed children's records and children's roster. Fireplace contains a screen. LPA observed all sharp utensils and medication are stored up high or in latched/locked cabinet which is inaccessible to children in care. Fire extinguisher, carbon monoxide alarm and smoke detector meet regulations.

During today's visit it was discovered the Linda Menefee has working at facility since July and does not have
clearances associated to the facility. Licensee states Ms. Menefee worked at facility previously then stopped working at the facility for a short time returning in July.

During visit LPA observed hygiene products in the medicine cabinet in the restroom accessible to children in care.

Licensee did not have a carbon monoxide alarm at the time of the visit.

Deficiencies cited during today's visit - see LIC809D
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2015
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEE, HEASOOK
FACILITY NUMBER: 304312418
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2015
Section Cited
102370(d)(2)
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Criminal Record Clearance. Prior to working, or volunteering in a licensed home, all licensees and personnel as specified shall request a transfer of a criminal record clearance as specified in Section 102370 (j).
During today's visit it was disclosed assistant Linda Menefee does not have clearances to facility.
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The licensee will have associated Ms. Menefee today.

An immediate civil penalty of $500.00 was assessed today.
Type A
09/14/2015
Section Cited
102417(g)(4)
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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.
During today's visit LPA observed personal hygiene products medicine cabinet in the restroom accessible to children.
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The licensee states she will remove the things from the medicine cabinet and send a picture to LPA
andrea.taylor@dss.ca.gov
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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: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2015
LIC809 (FAS) - (06/04)
Page: 2 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEE, HEASOOK
FACILITY NUMBER: 304312418
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2015
Section Cited
H&S1503.2
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Carbon monoxide detectors required; inspection:
Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8. Carbon Monoxide is not availabe in facility.
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Licensee stated she will purchase a carbon monoxide by 9/21/15.
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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: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2015
LIC809 (FAS) - (06/04)
Page: 4 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEE, HEASOOK
FACILITY NUMBER: 304312418
VISIT DATE: 09/14/2015
NARRATIVE
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Upon receipt of a Type A deficiency, licensee shall post and provide copies of this report to parents/guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee is to keep acknowledgement receipt signed by parents in each child’s file. Licensee shall provide copies of this document to parents/guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months”
Exit interview was conducted. The Notice of Site Visit was posted. Licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.

This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative
records.
The licensee/director was informed that the facility needs to update and amend the facility Plan of Operation to include the Incidental Medical Services (IMS). The Plan of Operations must be submitted to the Licensing office within 30 days of today's date. The plan should describe the facility’s policies and procedures that ensure the proper safeguards are in place. Topics to be covered include but not limited to:
· Types of IMS to be provided (Blood Glucose Testing; Inhaled Medication; EPI-PEN; Glucagon; G-Tubes; medications)
· Records and Authorizations
· Storage
· Staff training
· Safety precautions
· When to call 911
· Reporting Requirements

Refer to Title 22 Sections 101173 and 101226

The licensee/director was informed that child care staff must comply with Universal Precautions. The Universal Precautions must be posted in a prominent place in the area where the tests are performed.
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2015
LIC809 (FAS) - (06/04)
Page: 3 of 4