KAI MING HEAD START-GEARY CENTER

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Mok conducted an unannounced inspection for an unusual incident on 9/22/21. LPA met with the Site Director, Jee Young Cha,, Reginal Managers, Mei Hua Fu, and Ellen Peterson Allen and explained the purpose of the inspection to them. There were 17 preschooler & 14 Toddlers with 15 staff present. The facility submitted an unusual incident report to CCL on 9/27/21, a child who walked out of the facility by himself without care and supervision from any facility's staff during pick-up time on 9/22/21. The child was discovered walking down the street by one of the parents under 5 minutes. The parent contacted the family advocate who brought the child back to the center. See the next page of the deficiency that was cited during the inspection. SUPERVISORS NAME: Ali Zebila LICENSING EVALUATOR NAME: Cindy Mok LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021 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 2 FACILITY NAME: KAI MING HEAD START-GEARY CENTER FACILITY NUMBER: 384001291 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/12/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 10/12/2021 Section Cited HSC 1596.99(c)(3) 1 2 3 4 5 6 7§1596.99(c)(3) Levy of civil penalty in addition to suspension, temporary suspension, or revocation; amounts; regulations setting forth appeal procedures for deficiencies (c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, for any of the following serious violations: 1 2 3 4 5 6 7The facility created an action plan to avoid the same incident happens again. The facility also form the staff meeting about it,. LPA obtained the copies of the action plan and staff meeting material during inspection. The deficiency was cleared during the inspection. 8 9 10 11 12 13 14(3) Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age.This requirement was not met as evidenced by based upon the report, a child who walked out of the facility by himself without care and supervision from any facility's staff during pick-up time on 9/22/21. The child was discovered walking down the street by one of the parents under 5 minutes. This poses an immediate safety risk to children in care. 8 9 10 11 12 13 14Civil penalty was issued. An office meeting may be scheduled. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Ali Zebila LICENSING EVALUATOR NAME:Cindy Mok LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021

Type A citation - immediate risk to health, safety, or personal rights

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Mok conducted an unannounced inspection for an unusual incident on 9/22/21. LPA met with the Site Director, Jee Young Cha,, Reginal Managers, Mei Hua Fu, and Ellen Peterson Allen and explained the purpose of the inspection to them. There were 17 preschooler & 14 Toddlers with 15 staff present. The facility submitted an unusual incident report to CCL on 9/27/21, a child who walked out of the facility by himself without care and supervision from any facility's staff during pick-up time on 9/22/21. The child was discovered walking down the street by one of the parents under 5 minutes. The parent contacted the family advocate who brought the child back to the center. See the next page of the deficiency that was cited during the inspection. SUPERVISORS NAME: Ali Zebila LICENSING EVALUATOR NAME: Cindy Mok LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021 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 2 FACILITY NAME: KAI MING HEAD START-GEARY CENTER FACILITY NUMBER: 384001291 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/12/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 10/12/2021 Section Cited HSC 1596.99(c)(3) 1 2 3 4 5 6 7§1596.99(c)(3) Levy of civil penalty in addition to suspension, temporary suspension, or revocation; amounts; regulations setting forth appeal procedures for deficiencies (c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, for any of the following serious violations: 1 2 3 4 5 6 7The facility created an action plan to avoid the same incident happens again. The facility also form the staff meeting about it,. LPA obtained the copies of the action plan and staff meeting material during inspection. The deficiency was cleared during the inspection. 8 9 10 11 12 13 14(3) Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age.This requirement was not met as evidenced by based upon the report, a child who walked out of the facility by himself without care and supervision from any facility's staff during pick-up time on 9/22/21. The child was discovered walking down the street by one of the parents under 5 minutes. This poses an immediate safety risk to children in care. 8 9 10 11 12 13 14Civil penalty was issued. An office meeting may be scheduled. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Ali Zebila LICENSING EVALUATOR NAME:Cindy Mok LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021