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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313112
Report Date: 01/18/2023
Date Signed: 01/18/2023 10:37:15 AM


Document Has Been Signed on 01/18/2023 10:37 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:VO, THU TRUNGFACILITY NUMBER:
304313112
ADMINISTRATOR:VO, THU TRUNGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(657) 237-5044
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:14CENSUS: 7DATE:
01/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:THU VO, Licensee TIME COMPLETED:
10:45 AM
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This is a follow-up proof of correction inspection that was made by Licensing Program Analyst (LPA) Tran and LPA Chan. LPAs met with licensee, Thu Vo who guided the analysts on a tour of the facility. Census was taken as follow, 7 children including 2 infants.

A review of the Facility Personnel Report Summary on 01/18/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

An initial unannounced inspection visit was conducted on 12/05/2022 and a LIC 809D was completed. The deficiencies that were previously cited on a LIC 809D dated 12/05/2022 had been cleared. Acknowledgement of Receipt of Licensing Reports LIC 9224 was also observed in each of the child's file.

Exit interview was conducted. The Notice of Site Visit was posted. Licensee was advised the Notice of Site Visit must be posted for 30 days or 100$ Civil Penalty will be assessed.

(End of Report)
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
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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