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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412127
Report Date: 02/19/2020
Date Signed: 02/19/2020 03:25:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:TRINH, HIEN & NHUTFACILITY NUMBER:
434412127
ADMINISTRATOR:TRINH, HIEN & NHUTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 684-4249
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY:14CENSUS: 6DATE:
02/19/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Tuonglai TranTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Mahvash Behbood conducted an unannounced Required Annual visit. Met Tuonglai, Helper. Purpose of today’s visit explained. Neither one of the licensee's were present. Present also were 6 day care children ages 3 to 6 years old. Days and hours of operation is Monday - Friday, 8:00 AM - 5:30PM. All adults or other individuals who require caregiver background checks have received criminal record and child abuse index clearance or exemptions. Helper's CPR and First Aid are current and expire in 01/27/21. Helper has copies of the required immunization. Sample of children files reviewed, they contain children information and emergency contact information and other required document.

LPA toured the indoor and outdoor areas of the home during today's visit. LPA reviewed a current Child Care Facility Roster and Fire/Disaster Drill Log during today's visit. Last fire drill was conducted on 01/2020. There is a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA observed no wall heaters in the day care area. Off limit areas inside the home: entire second floor and garage. Off limit areas outside the home: 2 locked sheds and side yards.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, and no bodies of water. Licensee states she does not have any weapon in the home. All detergents, cleaning compounds, poisons, medications, are out of reach and inaccessible to children. Backyard where children play is fenced.

Periodic information releases accessible by signing up at: www.myccl.ca.gov


No citation issued during today's visit.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
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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