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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103901887
Report Date: 02/18/2020
Date Signed: 02/18/2020 12:52:08 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:NGUYEN, TRAM FAMILY CHILD CARE HOMEFACILITY NUMBER:
103901887
ADMINISTRATOR:NGUYEN, TRAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 435-5320
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:14CENSUS: 12DATE:
02/18/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tram NguyenTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced Annual/Random inspection and met with Licensee, Tram Nguyen and husband. LPA explained the reason of the inspection and a tour of the home was conducted both inside and outside. LPA observed licensee and husband caring for 12 children whom some were playing in the front yard with licensees husband while others were inside the house with the licensee.

Licensee stated that children only have access to the first floor of the home. Licensee has placed a children's safety gate at the start of her stairs to make the second floor inaccessible. All the closest and doors downstairs have plastic door knobs/spinners in place. The garage and laundry room are inaccessible to children. LPA observed plenty of age appropriate toys, cubbies, books, and small tables and chairs in the living room area. LPA also observed that the day-care home was clean. Licensee stores her knifes and sharp utensils inside a drawer that has a plastic latch. Licensee stores her cleaning supplies underneath her kitchen sink which also has plastic latch in place but is not functioning properly. Licensee placed the cleaning supplies inside the laundry room and stated that she will replace the plastic latches later this week. LPA observed licensees son prescribed medication inside one of the drawers. LPA reminded licensee that medication needs to be stored in areas that are inaccessible to children in care. Licensee stated that she will move all of her medication which is stored in a lower cabinet that also has a plastic latch. LPA reminded licensee that she needs to make sure the plastic latches are always functioning properly or she needs to replace them immediately or remove the items she stores. Licensee understood.

The bathroom is located next to the bedroom that's used for napping. LPA observed a Lysol bottle with a plunger and bathroom cleaner. There was a bucket in the shower which LPA advised licensee to remove in case water accumulates. Licensee removed these items and placed them in her garage. LPA observed cots, blankets, and three playpens in the napping room.

LPA spoke about the safe sleep regulations with the licensee and reminded her to not store anything inside the cribs and playpens. LPA provided her with a safe sleep brochure and the new lead guidelines.

Report continued onto LIC 809-C

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: NGUYEN, TRAM FAMILY CHILD CARE HOME
FACILITY NUMBER: 103901887
VISIT DATE: 02/18/2020
NARRATIVE
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Licensee has a 2A10BC fire extinguisher that was last serviced on 02/08/2019. LPA reminded licensee that it needs to be serviced or replaced yearly. Licensees CPR/First Aid certificate is good until 07/31/2021. The last time Licensee conducted the fire/emergency drills with children was on October 1, 2019. The carbon monoxide and smoke detector were tested and found in working condition. A sampling of 5 children's files were reviewed. LPA observed that the licensee did not have the 5 children's immunization forms along with their affidavit regarding liability insurance LIC 282. LPA provided copies of the missing paperwork. Licensee did not have a completed Children's roster and was missing 9 of the children present today.

The backyard has a fence that goes all around. LPA observed a pool which has a metal fence and a gate that's closed. Licensee has a glass sliding door which has a latch placed up high so children are not able to open the door. Licensee uses the front yard to play. LPA observed a small fence all around with age appropriate toys. Licensee stated that there are no weapons or ammunition in the home. Licensee is up to date with the immunization requirements per SB 792. Mandated Reporter Training AB 1207 was taken on 11/21/2018. Licensee stated she will retake it again this year.

Licensee is not providing Incidental Medical Services. 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

During today's inspection, The following Type A and Type B Deficiencies were observed and cited. Appeal rights were explained and provided to licensee, Tram Nguyen.

Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809, two (2) LIC 809 C, and LIC 809 D.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

LPA observed licensee post the Notice of Site visit.


FAILURE TO POST THE NOTICE
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: NGUYEN, TRAM FAMILY CHILD CARE HOME
FACILITY NUMBER: 103901887
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/19/2020
Section Cited

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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. This requirement was not met as
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evidenced by LPA observing Lysol, Windex, Ajax, Chlorine, and other cleaning solutions underneath the kitchen sink and bathroom. LPA also observed prescribed medication and sharp utensils in a kitchen drawer. This poses an immediate health/safety risk to children in care.
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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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: NGUYEN, TRAM FAMILY CHILD CARE HOME
FACILITY NUMBER: 103901887
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2020
Section Cited

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Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement was not met as evidenced by LPA conducting a
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file review and observing that a sampling of children did not have their immunization's on file. Licensee stated that she will get copies from their parents this week. This poses a potential health/safety risk to the children in care.
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Type B
02/28/2020
Section Cited

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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
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This requirement was not met as evidenced by licensee not having a completed roster. Out of the 12 children present today, only 3 were on the roster. This poses a potential health safety risk to the children in care
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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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4