414004649-1-2-2020-05-CC-KMEO-BKFU3K-20200102141340

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004649
Report Date: 01/02/2020
Date Signed: 01/02/2020 02:13:49 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, LINH		FACILITY NUMBER:	414004649
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	01/02/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Licensee, Linh Tran		TIME COMPLETED:	02:30 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	Licensing Program Analyst (LPA), Kassandra Medrano conducted a scheduled Pre Licensing inspection this day and met with Applicant, Linh Tran. LPA and Applicant inspected entire home for Health and Safety Hazards. Applicant rents home, which is a three (3) bedroom, three (3) bathroom, single level house. Applicant lives with adult son and daughter. Daycare area is: front room, kitchen, living room, front bathroom, bedroom adjacent to bathroom. OFF limit areas: bedroom #2 and #3 and two back bathrooms. All off limit areas are properly barricaded. Home has multiple working smoke detectors, a carbon monoxide detector, a working telephone, and a fully charged Fire Extinguisher. First Aid Kit is fully stocked and accessible. Licensee was also advised to conduct fire/disaster drills at least once every six months, and to log the date and time of the drill. All harmful and sharp objects are made inaccessible from children in care. Per licensee, there are no pets, no firearms or no weapons in the home. The home is clean and orderly with sufficient lighting and ventilation. Home has age appropriate toys and equipment available for the children in care. CPR/First Aid, 16hrs health and safety training has been completed and was current. Applicant will prepare meals for children. Discipline policy was discussed with applicant. Per Applicant, they do not have day-care insurance at the moment and Applicant was advised to use the LIC282, the Affidavit regarding liability insurance for FCCH, and submit copy of Liability Insurance to CCL office once purchased. Postings will be posted near main door. Applicant is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Applicant is advised all adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with copy of CDL or Ca. ID prior to having any contact with children in care failure to do so could result in an immediate civil penalty of $100.00 each day.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TRAN, LINH	FACILITY NUMBER: 414004649
	VISIT DATE: 01/02/2020

NARRATIVE

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Applicant was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.
Incidental Medical Services (IMS) policy was discussed. 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

Applicant was reminded about the Provider Information Notices (PINs) on the CCLD website.

A copy of A Child Care Provider’s Guide to Safe Sheet was provided to the Applicant.

Applicant was reminded of Mandated Reporter Training available on CCLD website.

This report is discussed and explained to the Applicant. Records to be Maintain in the facility is explained and left with the Applicant to use for all children in care. Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parent's Rights Poster. Capacity limits of the License has been discussed.

License will be recommended for approval when the following is updated and proof is received in office:
- Once family finishes moving into home, and LPA conducts another inspection.

This report will be kept in the facility file and will be made available for public review upon request. Desk duty is available M-F, 8a.m.-5p.m., (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020

LIC809 (FAS) - (06/04)

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