376619038-7-22-2022-51-CC-NDIZ-CGKMEC-20220722093231

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376619038
Report Date: 07/22/2022
Date Signed: 07/22/2022 09:32:45 AM

Document Has Been Signed on 07/22/2022 09:32 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	NGUYEN, HAI FAMILY CHILD CARE		FACILITY NUMBER:	376619038
ADMINISTRATOR:	HAI NGUYEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 693-9006
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	14	CENSUS: 2	DATE:	07/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Hai Nguyen		TIME COMPLETED:	09:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 7/22/22 @ 8AM, LPA Nancy Diaz conducted an unannounced inspection. LPA met with Hai Nguyen, Licensee. Also present were XuanLan Nguyen (helper) and Trinh Nguyen (grand daughter). Ms. Trinh Nguyen helped in translating this inspection in Vietnamese. Observed present today were 2 children. A tour of the home was conducted. The following areas are accessible to children daycare room, dining, bedroom to the left (for napping of infants), hallway bathroom and back fenced yard. Facility operates Monday-Friday; 8AM to 6PM. The licensee was present in the home to ensure that all children are supervised at all times. Facility is within capacity and did not exceed the capacity specified on the license. There were no bodies of water observed within the premises. Mrs. Nguyen stated that she does not maintain any weapons in the home. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored appropriately and inaccessible to children. Fire place is screened to prevent access by children. Fire extinguisher and smoke detectors meet State Fire Marshall standards. The carbon monoxide detector present in the home meet the standards established in Chapter 8 of Part 2, Division 12. Home is kept clean and orderly with heating and ventilation for safety and comfort. Licensee provide safe toys, play equipment and materials. The home maintains a working telephone service. Mrs. Nguyen has 2 infants in care (between the ages of 13 months to 17 months) Infants are not swaddled while in care. Infants are supervised while they sleep. The provider check on sleeping infants every 15 minutes. Documentation of infant napping log was reviewed. LPA provided licensee a sample log.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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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Document Has Been Signed on 07/22/2022 09:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: NGUYEN, HAI FAMILY CHILD CARE	FACILITY NUMBER: 376619038
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/22/2022

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
1 2 3 4	Based on LPA's observation, the licensee did not comply with the section cited above. Several items were accessible to children in the yard that poses a potential hazard if accessed. Storage shed was not locked; bar-b-que grill and toaster oven were accessible to children; roofing material and potting soil were stored in the yard. Construction equipment (cement mixer) was also observed in the yard that is accessible to children.
	POC Due Date: 07/25/2022
	Plan of Correction
1 2 3 4	Mrs. Nguyen stated that she will lock the storage shed and remove the bar-b-que grill, toaster oven, roofing material, potting soil and cement mixer no later than 7/25/2022. She will submit photos via email to: Nancy.diaz@dss.ca.gov

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's file review], the licensee did not comply with the section cited above. Mrs. Nguyen has 2 children under the age of 24 months in care. Mrs. Nguyen did not maintain a nap log. She stated that she does check on the infants at least once every 10-15 minutes, but did not maintain a nap log. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/01/2022
	Plan of Correction
1 2 3 4	Mrs. Nguyen stated that she will start maintaining a nap log and will send a sample log to the LPA no later than 8/01/2022. She will the sample nap log to: nancy.diaz@dss.ca.gov

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: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: NGUYEN, HAI FAMILY CHILD CARE	FACILITY NUMBER: 376619038
	VISIT DATE: 07/22/2022

NARRATIVE

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LPA discussed the safe sleep regulations with Mrs. Nguyen 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 Mrs. Nguyen 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.

Car seats are only used for transportation purposes and not used for sleeping. Infants are supervised while they sleep.

The outdoor play area is fenced or supervised by the licensee. An isolation area has been designated for children who became ill during the day.

Children’s records were reviewed. Licensee maintains a copy of the emergency information card that contains all of the information specified by the regulation.

Staff records were reviewed. Mrs. Nguyen and her helper are exempt from the Mandated Reporter course completion as their primary language is Vietnamese.
Helper XuanLan have been immunized against influenza, pertussis and measles. Licensee’s and helper CPR and First aid are valid thru January 2023.

Mrs. 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.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: NGUYEN, HAI FAMILY CHILD CARE	FACILITY NUMBER: 376619038
	VISIT DATE: 07/22/2022

NARRATIVE

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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

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.

A notice of site visit was provided and observed posted. This notice shall remain posted for 30 days.

Exit interview was conducted with Mrs. Nguyen. A copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC809 (FAS) - (06/04)

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