013422779-8-21-2020-52-CC-BPLY-BSPNZ8-20200821105357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422779
Report Date: 08/21/2020
Date Signed: 08/21/2020 10:54:05 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: 4	DATE:	08/21/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Hanh Phan		TIME COMPLETED:	11:15 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 08/21/20 at 10:35am, Licensing Program Analyst (LPA) Briana Plumboy conducted an announced Case Management Inspection via Facetime with Licensee Hanh Phan. Present for the inspection was 4 preschool age children. The home was virtually toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:30am until 5:30pm ON LIMITS: 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. OFF LIMITS: 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. The OUTDOOR play areas are fenced. The licensee utilizes the front yard and a portion of the backyard for childcare.There is a 2A10BC fire extinguisher, carbon monoxide detector, pull down fire alarm, and smoke detector which meet State Fire Marshall standards during today's inspection. Per licensee, there are no firearms in the home. There are no pets in the home. All required licensing documents are posted and visible for public review. The licensee's Pediatric CPR/First Aid certificate is current and expires 10/12/21. Licensee's mandated reporter training was completed on 05/05/20. Licensee is in compliance with the immunization law. 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: 08/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2020

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: 08/21/2020

NARRATIVE

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On 08/20/20, a fire clearance was granted to facility #013422779 by Union City Fire Department with no special conditions. All documents have been received for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

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 .

As of 08/21/20, this home is recommended for an increase of capacity. There are no deficiencies cited today. The report will remain on file for three years. A notice of site visit was provided, and the licensee was reminded to have it posted for 30 days. This entire report has been read to the Licensee by LPA Plumboy. The licensee is aware the signature on this report confirm receipt of these documents. LPA asked the licensee if the licensee had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensee, and per licensee, there are no further questions at this time. Licensee is aware at anytime she can reach out to LPA Plumboy or CCLD. An exit interview was conducted, and appeal rights provided.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2020

LIC809 (FAS) - (06/04)

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