Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312418
Report Date: 04/20/2017
Date Signed 04/21/2017 04:09:35 PM

COMPREHENSIVE INSPECTION
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: 13DATE:
04/20/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Heasook Lee-LicenseeTIME COMPLETED:
06:30 PM
NARRATIVE
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LPA Taylor toured areas of the home accessible to the children. Licensee stated that OFF LIMITS areas include: upstairs and garage. Licensee acknowledged that children may never enter these off-limit areas. The census included 13 daycare children. Also present was the licensee's assistant who also has been fingerprint clearances. 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.

LPA observed current CPR and First Aid certificates(exp: 8/27/18), posted Parent's Rights and current disaster plan. Fireplace contains a screen. Fire extinguisher, carbon monoxide alarm and smoke detector meet regulations. All sharp utensils are stored up high and/or latched or locked which are inaccessible to children in care. Medications are stored up high and also inaccessible to children in care. Toys appear to be safe. The backyard is fenced. Children's records and staff records were reviewed.

Deficiency cited during today's inspection - see LIC809D

LPA observed Lysol Spray, Lysol Wipes and Glade air freshener on top of a filing cabinet with a trash can and a chair in front of the cabinet. The chair and trash can make these products accessible to children in care.
LPA observed a baby walker in the back yard were the children play. Baby walkers are not allowed at licensed day care facility.
During today's inspection LPA Taylor observed an infant put in a "Fisher Price" sleeper chair and the infant went to sleep in the sleeper chair. These chair are not allowed in a licensed per regulations.
While reviewing children's records it was discovered 2 children did not have any required forms on file.
It was discovered a few of the other children in care do not have all of the forms required on file.
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2017
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: 04/20/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/27/2017
Section Cited
102421(b)
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Child's Records. The licensee shall maintain, in each child’s record, a copy of the emergency information card required in Section 102417(g) (7).
During review of children's records it was discovered 2 children had no required forms on file. Several other children had only some forms.
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Ms. Lee stated she will have the parents fill out the forms and send the forms to LPA.

andrea.taylor@dss.ca.gov
(714) 703- 2831 Fax
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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: 04/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2017
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: 04/20/2017
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.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

Exit interview was conducted. Report and deficiencies were reviewed during inspection. The Notice of Site Visit was posted. Facility representative 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.

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Doucments/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Doucments/ChildCareProvSleepSPAN2011.pdf
Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

The facility representative was informed that the CRIMINAL RECORD STATEMENT (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov


Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2017
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: 04/20/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/20/2017
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.
LPA observed Lysol Spray, Lysol Wipes and
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Ms. Lee moved the "Lysol Spray, Lysol Wipes, and Glade Air Freshener" to a location which is not accessible to children in care.
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Glade air freshener on top of a filing cabinet with a stool and a chair in front of the cabinet. The chair and stool make these products accessible to children in care.
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andrea.taylor@dss.ca.gov
(714) 703-2831 Fax
Type A
04/20/2017
Section Cited
102417(g)(10)
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Operation of a Family Child Care Home. A baby walker is not permitted on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).
During today's visit LPA Taylor observed an infant put in a "Fisher Price" sleeper chair
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Ms. Lee removed the infant from the sleep chair and placed infant in a pack n play. Ms. Lee removed both the "Fisher Price" sleep
chair and the walker from the home during the inspection
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and the infant went to sleep in the sleeper chair.
Also, LPA observed a baby walker in the back yard where the children play.
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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: 04/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2017
LIC809 (FAS) - (06/04)
Page: 3 of 4