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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414003086
Report Date: 05/01/2019
Date Signed: 05/01/2019 03:34:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:TRAN, ANDY N.FACILITY NUMBER:
414003086
ADMINISTRATOR:TRAN, ANDY N.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 281-1556
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:14CENSUS: 11DATE:
05/01/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Andy Tran TIME COMPLETED:
03:45 PM
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Licensing Program Analyst Glenn Schnell conducted a case management inspection to follow up on the non-compliance conference that was conducted on November 15, 2018.

During the inspection a review of adults working and living in the home was conducted.
The licensee participates in a program that hosts international students. There are currently three students in the home over 18 all with criminal background and child abuse index clearances. Other adults that live in the home in addition to Andy are his wife, Linh, and his adult daughter Kaitlyn. Andy has two children under 18 that also live in the home. One of the two children is turning 18 at the end of 2019. LPA Schnell explained the requirements for adults living in the home with Andy today.

Based on the review of requirements for adults living and working in the home, it has been determined that Andy understands the responsibility to comply with the Title 22 Regulations.

No deficiencies cited today.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
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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