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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422779
Report Date: 07/12/2021
Date Signed: 07/12/2021 01:49:38 PM

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, HANHFACILITY NUMBER:
013422779
ADMINISTRATOR:PHAN, HANHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 499-2686
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 11DATE:
07/12/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Hanh Phan- LicenseeTIME COMPLETED:
01:55 PM
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On 07/12/21 at 1:14pm, Licensing Program Analyst (LPA) Briana Plumboy conducted an unannounced Case Management Inspection with Licensee Hanh Phan. Present for the inspection was 2 infants, 9 preschool age children, licensees teenage daughter whom is not included in her ratio, licensees fingerprint clear and associated husband Son Ly and 2 fingerprint clear assistants named Kim Blood and Ana Phann. The home was toured. 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. As of 7/12/21, the family room is also included in the on limits area.

OFF LIMITS: the kitchen, the 2 bedrooms located in the hallway, the master bedroom and 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 during the inspection and the bedroom doors which lead to the off limit bedrooms are closed during today's inspection. There is a fireplace located in the family room which is barricaded during today's inspection.

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 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 NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021
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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