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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407686
Report Date: 02/21/2025
Date Signed: 02/21/2025 01:14:44 PM

Document Has Been Signed on 02/21/2025 01:14 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SANDERS, NGUYENFACILITY NUMBER:
434407686
ADMINISTRATOR/
DIRECTOR:		SANDERS, NGUYENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4083651328
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 2DATE:
02/21/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Nguyen SandersTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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At 8:30 am, Licensing Program Analysts (LPAs) Syeda Bahar and Mandeep Kaur met with Licensee, Nguyen Sanders, for an unannounced annual/random inspection. Present during the inspection were – the Licensee, (2) two children and (1) one infant. Days and hours of operation are from Monday to Friday, 6:00 am to 6:00 pm. The ages of the children to be served are from 0 months to 6 years. The LPAs toured the indoor and outdoor areas home to conduct a Health and Safety Inspection.
On Limits Area: First floor- Living Room, Kitchen/Dining Room, playroom, bathroom, and backyard.
Off Limits Area: Entire upstairs, laundry room, living room, and attached garage.
Isolation Area: Family room area beside the kitchen area.

The home is clean and orderly, with heating/air conditioning, ventilation for safety and comfort. LPAs observed a fully charged 3A10BC fire extinguisher, working smoke and carbon monoxide detectors and working telephone. Licensee conducted the last fire/disaster drill on 01/07/2025. There are ample age-appropriate toys that appear to be safe and in good condition. The bathroom is observed to be clean, sanitary, and operable. The outdoor play area is fenced. There are no bodies of water observed. LPAs observed sharp objects in a kitchen drawer that is accessible to the children and were removed by licensee during today’s inspection. Furniture and equipment were observed to be age appropriate and in good condition. Licensee has pets(two dogs) in the day care home. The dogs were in the off-limits area. LPAs observed a fireplace, that is not screened, and it is located in the off-limit family room, that is accessible to the children. Licensee was advised to screen the fireplace area as it is accessible to the children for the health and safety of the children.

Licensee provides morning and afternoon snacks. Licensee stated that children bring foods from their home. Licensee was reminded that any food or water bottles or sippy cups are brought from home shall be labeled with each child's name. Licensee understands that smoking is prohibited in the home.

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Belinda DevallTELEPHONE: (408) 598-5501
Syeda BaharTELEPHONE: (408) 834-2558
DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SANDERS, NGUYEN
FACILITY NUMBER: 434407686
VISIT DATE: 02/21/2025
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***Page 2***
Licensee has a valid CPR and First Aid, completed on 11/10/2024 (expires 11/10/2026). Licensee completed Mandated Reporter training on 01/9/2025 (expires on 01/9/2027). LPAS observed that, (1) one adult assistant (S2) did not have updated Mandated Reporter Training Certification and missing TB Test results for review. Licensee was reminded of Mandated Reporter Training (AB1207) and CPR, First Aid certifications needs to be renewed every two years. Licensee’s immunization records are on file. Per Licensee, there is a firearm in the home. Licensee stated that the firearm belongs to her husband, and it is stored separately. Licensee stated that she does not know the code of the locker. LPAs observed the place where the firearm is stored. Child’s records are available for review and contain all required forms. All required forms are posted and visible for public review.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

There were no baby walkers or bouncers observed in the on-limit areas for the children. Licensee understands that baby walkers or other similar items are not permitted for the children. All cribs or play yards meet the safety standards. The cribs or play yards do not hinder entrance or exit to and from the space where infants are sleeping. The mattresses in the crib or play yards are firm and covered with a fitted sheet that is appropriate, fits tightly, and overlaps the underside of the mattresses. Each infant’s bedding is used for them only and cleaned weekly or before use by another infant. There are no loose articles and objects, bumper guards or objects hanging above or attached to the side of the cribs or play yards. Licensee was reminded to maintain Individual Infant Sleeping Plan for each infant under 12 months of age, and keep it in the file signed and dated by the infant’s authorized representative, including the infant’s sleeping positio. Licensee has the documentation of 15-minute checks for the infant.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

Forms of discipline to be used by Licensee are redirecting and talking with the child. Licensee understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, children are treated with dignity, receive safe, healthful, and comfortable accommodations, interference with eating, intimidation, or other actions of a punitive nature.
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SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Syeda BaharTELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SANDERS, NGUYEN
FACILITY NUMBER: 434407686
VISIT DATE: 02/21/2025
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***Page 3***

Licensee states that she does not administer any medications to the day care children at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/. Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, Nguyen Sanders, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Megan's Law was checked on 01/14/2025. To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

During today’s inspection, (2) Two “Type B” deficiency(s) are issued on attached 809-D. Appeal rights provided.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Nguyen Sanders.
SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Syeda BaharTELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/21/2025 01:14 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: SANDERS, NGUYEN
FACILITY NUMBER: 434407686

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
HSC
1596.8662(b)(1)
1596.8662
Administration of child day care licensing: (b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and records review, the licensee did not comply with the section cited above. One of the staff (S2) out of three staff is missing current Mandated reporter training (AB1207), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2025
Plan of Correction
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By plan of correction due date, 03/07/2025, Licenseen will submit the copy of the current certificate of Mandated reporter Training(AB1207) to the department for Staff (S2).
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing: (c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews and records review, the licensee did not comply with the section cited above ifor a Staff (S2) who does not have TB test results on file to review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2025
Plan of Correction
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By Plan of correction due date, 03/07/2025, Licensee will submit the copy of the TB test results to the department for a staff (S2).
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Belinda DevallTELEPHONE: (408) 598-5501
Syeda BaharTELEPHONE: (408) 834-2558

DATE: 02/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2025

LIC809 (FAS) - (06/04)
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