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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422779
Report Date: 02/01/2023
Date Signed: 02/01/2023 10:02:48 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/01/2023 10:02 AM - It Cannot Be Edited

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:
02/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:22 AM
MET WITH:Hanh Phan- LicenseeTIME COMPLETED:
10:10 AM
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On 2/1/23 at 8:30am, Licensing Program Analyst Briana Plumboy met with licensee Hanh Phan for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was licensees fingerprint clear and associated assistants Ana Phann & Kim Chi D Blood, 4 infants, and 7 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. ON LIMITS: the living room, family room, dining room, hallway bathroom, and the the bedroom located off the kitchen 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. 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, and working telephone. The licensee's CPR and First Aid certificate is current and expires 10/2/23. The licensee and assistants present today are in compliance with the immunization law. 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 12/2/22. The licensee received as certificate in mandating reporting on 1/4/23, and assistants Ana Phann & Kim Chi D Blood are aware they must complete the training when it's available in Vietnamese. 4 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 NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
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: 02/01/2023
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Incidental Medical Services (IMS) policy was discussed. 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

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, 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



LPA discussed the safe sleep regulations with licensee Hanh Phan and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Hanh Phan of the importance of checking for 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.

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

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Hanh Phan.

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

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC809 (FAS) - (06/04)
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