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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414003086
Report Date: 12/04/2019
Date Signed: 12/04/2019 10:20:10 AM

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: 10DATE:
12/04/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Andy TranTIME COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Van and Bashir-Tariq conducted an unannounced case management and met with Licensee, Andy Tran. LPAs explained the purpose of the inspection and granted entry to the facility by the licensee. Present, there are two helpers, the licensee and 10 children (2 infants and 8 preschoolers). The facility is operating within teachers/children ratio.

LPAs reminded licensee again regarding an outstanding balance on the civil assessments penalties that were issued on 9/26/18. The licensee stated that he had contacted Sacramento headquarter and a representative said Sacramento will sent the billing statement to the licensee. LPAs reminded licensee that unpaid civil penalties could lead to additional legal action from the Department.

Licensee is not using the main home building as a licensed day care area at this point. The big room at the back of the home is only day care area. Licensee obtained the fire clearance for the room already. LPAs observed learning materials, toys and books were available to the children in care in the room. There is a separate bathroom installed for children. Entry to the room is through the side door of the home, around the back yard. LPAs observed that there were multiple smoke and carbon monoxide detectors installed in the room. In addition, LPAs also reminded licensee to obtain fingerprints clearance for the son, who turned 18 today. LPAs provided FCCH annual checklist to the licensee.

An exit interview was conducted with the licensee. This report and rights to comment were discussed with the licensee. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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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