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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313186
Report Date: 07/09/2026
Date Signed: 07/09/2026 12:43:11 PM

Document Has Been Signed on 07/09/2026 12:43 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LEE, JINFACILITY NUMBER:
304313186
ADMINISTRATOR/
DIRECTOR:		LEE, JINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 822-9947
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
07/09/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Lee, Sub (Facity Represtative)TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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LPA uses Interpreting Service to conduct a visit with Licensee (Translator ID # 63467827)

On 07/09/2026, an unannounced Annual/Random inspection was conducted at the facility by Licensing Program Analyst (LPA) V. Trinh. LPA observed the assistant caring for a total of four (4) children, including one (1) licensee’s child, children were eating. Around 9:25 am another children attended to the day care. The licensee on the phone stated that the total enrollment is five (5), and that children are on a staggered schedule and arrive at different times throughout the day and are aware that they cannot exceed the capacity ratio of 14 children at any one time. The facility was operating within the licensed capacity as specified on the license.



CRIMINAL RECORD CLEARANCE: A review of the Facility Personnel Report Summary on this date 07/09/2026 indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently, there are two (2) adults, including the licensee and two (2) minor child, living in the facility. Facility Day care hours are 7:00 AM-7:00PM, Monday through Friday.

Durning today’s indoor inspection. The LPA inspected the indoor FCCH (Family Child Care Home) area identified in the Facility Sketch LIC999 and areas accessible to children. Off-limits areas were inaccessible to children in care with child gates, at the time of inspection. The facility is single-family home. The child care area, which is accessed through the main door and consists of the family room, playroom. The family room is used as a classroom for preschool children, the playroom is the infant care area, and the front yard is used as the playground.

INDOOR INSPECTION: The childcare area consists of the childcare room, accessible through the front door. The children use the restroom adjacent to the childcare room. The day-care areas consisted of a living room, bedroom 2, bathroom adjacent to bedroom 2, and front yard (fenced). During today's inspection, each child was observed to have safe, healthful, and comfortable accommodations, furnishings, and equipment.

Continued page 2.
NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/09/2026 12:43 PM - It Cannot Be Edited


Created By: Vivian Trinh On 07/09/2026 at 11:15 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LEE, JIN
FACILITY NUMBER: 304313186

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review. The licensee did not comply with the section cited above. During the inpection LPA observed, there were cleaning compounds Lysol accessible in the day care children's bathroom, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/17/2026
Plan of Correction
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The Assitant stated they will submit photos to LPA via email by due date showing that all cleaning compounds, are inaccessible to children in care.
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review. The licensee did not comply with the section cited above. LPA observed the Assistant did not have any documentation that shows she was conducting fire and disaster drills, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/17/2026
Plan of Correction
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The assitant will practice the fire drill and email the documentation to the LPA by the due date
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2026


LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 07/09/2026 12:43 PM - It Cannot Be Edited


Created By: Vivian Trinh On 07/09/2026 at 11:15 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LEE, JIN
FACILITY NUMBER: 304313186

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(1)(B)(ii)(I)
Pool Safety
(ii) (I) An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review. The licensee did not comply with the section cited above in. The assistant did not have working pool cover or alarm working, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/17/2026
Plan of Correction
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Assistant stated that they will submit proof of pool cover or alarm to LPA via email by due date.
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review. The licensee did not comply with the section cited above. LPA oberved Child #4 present did not have child records available for review during the time of inspection, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/17/2026
Plan of Correction
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 Assistant stated that they will submit copies of files for Child #4 children enrolled to LPA via email by due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2026


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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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEE, JIN
FACILITY NUMBER: 304313186
VISIT DATE: 07/09/2026
NARRATIVE
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ON-SITE FOOD PREPARATION: The facility does provides breakfast, lunch, and snacks to the children. At the time of inspection, food prep areas were clean and sanitary, and food was properly stored. Filtered drinking water is available to children's in care. The LPA observed that the facility’s floors, equipment, furniture, and children’ bathrooms were clean and in good repair.

OUTDOOR INSPECTION: The front playground was enclosed by a fence. The outdoor equipment and toys were in good repair and free of sharp edges. At the time of inspection, the outdoor activity area was well maintained and free of any observable hazards. Children will be able to have outside play in the enclosed front yard. During today's inspection, each child was observed to have safe, healthful, and comfortable accommodations, furnishings, and equipment.

Garage will not be used for day care. The Licensee stated the garage will be off-limits.

Licensee stated that they do not use the backyard for outdoor play. There is an in-ground swimming pool in the backyard. LPA inspected and completed the bodies of water checklist.

Bodies of Water: The facility has a pool with a surrounding gate that has a minimum height of 60 inches and an access gate that opens away from the swimming pool and is self-closing with a self-latching, key lockable device placed no lower than 60 inches above the ground. A maximum vertical clearance of two inches from the ground to the bottom of the enclosure. No gaps or voids that can allow the passage of a sphere with a diameter equal to or greater than four inches. Based on observation and interview, the licensee did not comply with the section cited above in that, licensee did not have working pool cover or alarm working, which poses a potential health, safety or personal rights risk to persons in care. (see LIC 809D for deficiency). A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard. A rescue pole with a body hook and a minimum fixed length of 12 feet. The licensee has a daily inspection log of the drowning prevention safety features and safety equipment that was available upon request.

LPA discussed Assembly Bill 2866 regarding in-ground swimming pool safety requirements and provided licensee PIN 25-01-CCP Chaptered Legislation Affecting Childcare Facilities.

There are working carbon monoxide, smoke detectors, that should be type 2A-10BC, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible location to children. Based on observation and interview, the assistant did not comply with the section cited above in that, there were cleaning compounds Lysol accessible in the day care bathroom. License stated there are not firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections.
Continue Page 3.
NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEE, JIN
FACILITY NUMBER: 304313186
VISIT DATE: 07/09/2026
NARRATIVE
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The Assistant is aware that each FCCH shall conduct fire drills and disaster drills at least once every six months. Based on observation, interview, and record review, the Assistant did not comply with the section cited above. During document reviews, LPA observed the Assistant did not have any documentation that shows she was conducting fire and disaster drills (see LIC 809D for deficiency). LPA verified there is a working telephone service (cellular service), licensee was reminded that childcare phone needs to remain the in the childcare at all times. Licensee stated they use the backyard for outdoor play.

The licensee does have a current roster of children in care of only four (4) children records for children present during the LPA inspection time. Based on interview and record review, the licensee did not comply with the section cited above in that, Child #4 present did not have child records available for review during the time of inspection (see LIC 809D for deficiency). Children’s records for children present during LPA inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700), Immunization records, Affidavit Regarding Liability Insurance (LIC282), Consent for Emergency Medical Treatment (LIC627), Notification of Parents’ Rights (LIC995A) and found to be in compliance. The licensee stated that there is an two (2) infant under 24 months enrolled in the childcare. LPA reviewed LIC 9227 Individual Infant Sleeping Plan and napping log for infants.

The licensee and assistant’s Pediatric CPR/First Aid certification expired 7/31/2027. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states that a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis and measles for the licensee and the assistant was reviewed and found to be in compliance.
Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training and renew it every 2 years. Based on observation, interview, and record review. The licensee did not comply with the section cited above, LPA observed the Assistant Mandated Reporting Training Certificate expired on 7/18/2025.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Continued Page 4

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEE, JIN
FACILITY NUMBER: 304313186
VISIT DATE: 07/09/2026
NARRATIVE
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The Assistant Lee, Sub understands he must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunization's, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

CCLD website www.cdss.ca.gov/inforesources/community-care-licensing was provided to the licensee to access regulations, updates, and licensing forms. Licensee was advised to register through [email protected] in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee.
LPA discussed the safe sleep regulations with Assistant Lee, Sub and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Assistant Lee, Sub was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.


LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian. Continued page 5.
NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEE, JIN
FACILITY NUMBER: 304313186
VISIT DATE: 07/09/2026
NARRATIVE
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The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: Operation of a Family Child Care Home 102417 (g)(4), CCR 102417(g)(9)(A). Pool Safety HSC 1596.814(a)(1)(B)(ii)(I), HSC 1597.622(b)(1), and Child Record, CCR 102421(a). (see LIC 809D)

Assistant Lee, Sub ,was reminded that all adults 18 and over living or working in the home, 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 exemption, prior to initial presence in a licensed Family Child Care Home. 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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the exit interview, the Assistant Lee, Sub , confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights

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

End of Report.
NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC809 (FAS) - (06/04)
Page: 8 of 9
Document Has Been Signed on 07/09/2026 12:43 PM - It Cannot Be Edited


Created By: Vivian Trinh On 07/09/2026 at 12:19 PM
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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LEE, JIN
FACILITY NUMBER: 304313186

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(b)(1)

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review. The licensee did not comply with the section cited above, LPA observed the Assistant Mandated Reporting Training Certificate expired on 7/18/2025, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/17/2026
Plan of Correction
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Assitant states will submit the updated/current Mandated Reporter training certificate to LPA by the due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2026


LIC809 (FAS) - (06/04)
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