376625415-7-11-2022-20-CC-LGAO-CG8SQE-20220711140436

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376625415
Report Date: 07/11/2022
Date Signed: 07/11/2022 02:09:04 PM

Document Has Been Signed on 07/11/2022 02:09 PM - 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:	TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE		FACILITY NUMBER:	376625415
ADMINISTRATOR:	XUAN TA & NHUT NGUYEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 452-8521
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	14	CENSUS: 5	DATE:	07/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Xuan Ta		TIME COMPLETED:	02:15 PM

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 July 11, 2022, at 10:15 AM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with co-licensee, Xuan Ta. LPA disclosed the purpose of the inspection and was granted entry into the facility by the co-licensee. Co-licensee speaks very limited English but analyst was able to conduct the visit with assistance from the Language Link Translation Service as well as the licensee's adult children who, though they were not in the home, provided translation for analyst when additional questions arose. Five (5) children including the licensee's grandson were in the home today. However, the licensee's grandson is not part of the daty care as he is under the direct supervision at all times of his mother, the cleared and associated Christine Nguyen, who lives in the home. This facility is a one floor, five bedroom, two bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: the kitchen, the living room, the family room and the day care bathroom. Off limits areas are the five home bedrooms, the second bathroom and the garage. The first two bedrooms and the second bathroom are in a separate portion of the home and are made off limits with an entry door with a door knob cover on it. The remaining three bedrooms are made off limits with door locks.The garage is made of limits with a door knob cover and high placed latch. The fire extinguisher and smoke detector met requirements. Most hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced backyard but only a patio portion that is gated off is available for children for outdoor activities. The remainder of the yard will be off limits and will not be able to be accessed by the children due to the installed gating which has a lock on it. No bodies of water observed on the premises during the inspection. Co-licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

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 07/11/2022 02:09 PM - 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: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE	FACILITY NUMBER: 376625415
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(4)

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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst observation, the licensee did not comply with the section cited above as analyst found cleaners including liquid detergent and insect repellent on the floor directly adjacent from the bathroom, in the cabinet with a broken latch beneath the kitchen sink and with knives in a drawer with a broken latch which poses an immediate health, safety or personal rights risk to children in care.
	POC Due Date: 07/13/2022
	Plan of Correction
1 2 3 4	Licensee removed hazardous items during visit and states will have working latches installed in respective kitchen cabinet and drawer and send analyst a photo displaying the installation of the latches by 07/13/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

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: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE	FACILITY NUMBER: 376625415
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.543

Licensure Requirements

Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst observation, the licensee did not comply with the section cited above as her carbon monoxide detector was not operational due to a missing battery which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 07/11/2022
	Plan of Correction
1 2 3 4	The deficiency was corrected when licensee installed batteries while analyst was present and analyst tested the detector and found it operational. Licensee understands that she should test the carbon monoxide detector on a regular basis to make sure it is working.

Type B

Section Cited

CCR

102417(g)(9)(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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst observation, the licensee did not comply with the section cited above as emergency drill have not been conducted in the home since November of 2017 which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 07/18/2022
	Plan of Correction
1 2 3 4	The licensee states she will conduct both earthquake and fire drills and then send analyst a copy of the documentation of the drills by 07/18/22 to demonstrate that the correction has been completed.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/11/2022 02:09 PM - 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: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE	FACILITY NUMBER: 376625415
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst observation and record review, the licensee did not comply with the section cited above as she had no files for children #1, #2 and #3 which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 07/18/2022
	Plan of Correction
1 2 3 4	Licensee states she will give a copy of the record packet to each parent and then send a copy of a completed file of any child of her choice to analyst by 07/18/22 to complete the correction.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst observation and record review, the licensee did not comply with the section cited above as she did not have an updated facility roster which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 07/18/2022
	Plan of Correction
1 2 3 4	Licensee states she will fill out a new roster listing all the children she has in care and submit a copy to analyst by 07/18/22 to complete the correction.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

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: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE	FACILITY NUMBER: 376625415
	VISIT DATE: 07/11/2022

NARRATIVE

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Licensees' First Aid and CPR certifications expire on 01/21/23. Licensee has required immunizations. Co-licensee is currently exempt from Mandated Reporter Training. Facility roster is not maintained to reflect current census. The last fire and disaster drills were conducted and documented in November of 2017. Licensee currently has no infants in care but analyst provided her with a copy of the safe sleep regulations for her to review at a future date.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov

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.

One type A and four type B violations California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

Upon Receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

LIC809 (FAS) - (06/04)

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