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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103901887
Report Date: 12/15/2021
Date Signed: 12/16/2021 12:32:16 PM

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: 9DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Tram NguyenTIME COMPLETED:
05:00 PM
NARRATIVE
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On December 15, 2021 Licensing Program Analyst (LPA) Brannon, conducted an unannounced Annual Required Inspection and was met by Licensee, Tram Nguyen. Also present was Staff #1 (S1). Days and hours of operation are Monday through Friday, 7:30 AM to 6:00 PM. Per licensee, she does not provide overnight care.

Upon arriving at facility, licensee and staff were not wearing the required face coverings to assist in mitigation of the spread of the COVID virus. LPA reviewed the following with licensee. California workplace safety and health laws require employers to take steps to protect workers exposed to infectious diseases and to prevent the spread of disease. Employers who fall under the scope of the Cal/OSHA COVID-19 Prevention Emergency Temporary Standards (ETS) must remain in compliance with the ETS. Pursuant to the Order of the State Public Health Officer (June 11, 2021), child care providers must comply with requirements in the Guidance for the Use of Face Coverings issued by the California Department of Public Health (CDPH). This public order was issued under the authority of Health and Safety Codes. The current CDPH Guidance for the Use of Face Coverings (July 28, 2021) requires all individuals in child care settings wear face coverings while indoors, regardless of vaccination status.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed. Licensee confirmed that the kitchen, bathroom, nap room and living room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of spinning doorknob covers and the stairs are barricaded to prevent children from climbing upstairs, where the rooms are off-limits to day care children. Stairs are fenced or barricaded when children under age 5 years old are present. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed with licensee the contact phone number is (559) 435-5320.

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SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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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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: 12/15/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation of knives that were accessible to children in care. During the inspection, the children were eating and placed in high chairs or sitting on the child size table with licensee present. The licensee did not comply with the section cited above, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/29/2021
Plan of Correction
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Per licensee, she will utilize the safety locks on the drawers. During today's visit, licensee activated the magnetic safety lock. LPA will conduct a follow up visit to ensure the safety latches are being used.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: 12/15/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(5)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. (A)Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation that the pool gate only self-latched sometimes depending upon the distance of the open gate. The door leading to pool area has two locking mechanisms. One that is on the top of the patio door way. Licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/29/2021
Plan of Correction
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Per licensee, she will tighten the pool gate spring to ensure that the pool self-latches at any distance. LPA will conduct a follow up visit.
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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 7 of 7
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: 12/15/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on children #1, #2, #3 and #9 are missing the required form during reviewing of children's files. The licensee did not comply with the section cited which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/29/2021
Plan of Correction
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Per licensee, she will have the missing forms completed by parents and place in children's files for review. LPA will conduct a follow up visit.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with licensee, the 15 minute infant sleep is not documented. The licensee did not comply with the section cited above with all three infants in care. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/29/2021
Plan of Correction
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Per licensee, she will include documenting the 15 minute sleep log for infants. LPA will conduct a follow up visit.
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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: 12/15/2021
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LPA observed two kitchen drawers with knives. Per licensee, she is utilizing magnetic locks to keep the items inaccessible to children. During today’s visit, the magnetic locks were not activated. Licensee conduct and documents fire drills. However, licensee failed to include the dates of the fire drills for July and August 2021.

Swimming pool is fenced per regulation. The pool gate is self-latching and opens away from the swimming pool. The gate self-latches when there is a large distance between gate and lock. The gate does not self-latch when the distance between the open gate and lock is less than 12 inches. No windows or doors have direct access to the pool area. Licensee has installed wrought iron fences against the window.

There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

The fireplace located in the living room is made inaccessible by a shelving and drawers and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

During today’s visit, there were three infants between the ages 12 months and 24 months. There is one crib or play yard for each infant in care and there are no objects hanging above. LPA observed blanket and elongated toy hanging off the inside of two different play yards. Assistant removed items when LPA pointed them out. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes. Licensee stated that she was not aware of the 15-minute log to document the time when licensee or staff checks on the sleeping infant. Staff stay in the room when the infants and children are sleeping. LPA reviewed with licensee the requirement of keeping the door leading to the nap room is to remain open when an adult is not present. LPA recommend allowing more light into the room when infants and children are napping. This will assist when visually observing sleeping infants and children. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is not required at this time due to not providing care to infants under 12 months. Infants up to 12 months of age are placed on their backs for sleeping.

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SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: 12/15/2021
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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. LPA provided a copy of an example of the 15 minute log and a copy of Title 22, section 102425: Infant Safe Sleep.

Per licensee, she ensures that children in care are always supervised and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 2/24/21. Licensee’s pediatric CPR/First Aid expires on 10/23/23. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. Licensee, Tram Nguyen, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Per licensee, there are no excluded individuals present at this home. LPA reviewed with licensee the requirement for adult children to be fingerprinted, TB tested and sign the LIC 508 Criminal Record Statement. Licensee’s adult child is away, attending college. However, he does come home during the holidays and sometimes in the summer or may not if he is taking summer classes and his permanent address is her home.


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SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: 12/15/2021
NARRATIVE
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This facility provides Incidental Medical Services – IMS. Currently, licensee does not have children who require IMS. LPA reviewed the following with licensee: For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Home Section 102417. 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.ht

LPA and licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D). Licensee was provided a copy of appeal rights.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with licensee, Tram Nguyen.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia BrannonTELEPHONE: (559) 388-3635
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 6 of 7