013422779-1-16-2020-52-CC-BPLY-BKVP32-20200116095649

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422779
Report Date: 01/16/2020
Date Signed: 01/16/2020 09:56:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	PHAN, HANH		FACILITY NUMBER:	013422779
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	01/16/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:21 AM
MET WITH:	Hanh Phan		TIME COMPLETED:	10:05 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 04/11/19, Licensing Program Analysts Briana Plumboy and Junell Chen, met with licensee Hanh Phan for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was licensees fingerprint clear and associated mother Hien Nguyen, 1 infant, and 2 preschool age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:30am until 5:30pm. The home consists of 4 bedrooms, 2 bathrooms, living room, family room, garage, dining room, and kitchen. The ON LIMIT AREAS are the living room, dining room, hallway bathroom, and the the bedroom located off the kitchen area is also an on limits to children in care. The bedroom located off the kitchen has a standing support bar bolted into the wall. Licensee is aware she must supervise the children while in use, as well as maintain the bar as well as the overall facility. The OFF LIMIT AREAS are the kitchen, family room, the 3 bedrooms located in the hallway, the master bathroom, and garage which will be inaccessible by closed and/or locked doors and visual supervision. The licensee has child safety gates in place to prevent access to the off limit areas. The ISOLATION AREA will be the bedroom located off the kitchen. Licensee is aware to contact LPA to change on or off limit areas. The OUTDOOR play areas are fenced. The licensee utilizes the front yard and a portion of the backyard for childcare. The licensee is aware that baby walkers, bouncers, exersaucers and jumpers are not allowed in licensed care. There are toys and learning materials. There are no pools, hot tubs or any other bodies of water present during the inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible during the inspection. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and fully stocked First Aid Kit. The licensee CPR and First Aid certificate is current and expires 10/12/21. The licensee is in compliance with the immunization law. The fireplace is blocked and screened to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 12/06/19. The licensee received as certificate in mandating reporting on 03/27/18, and her mother Hien Nguyen currently has a waiver for the mandated reporter training certificate until it is available in her primary language. (3) Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PHAN, HANH	FACILITY NUMBER: 013422779
	VISIT DATE: 01/16/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

LPA Plumboy provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC809 (FAS) - (06/04)

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