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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412847
Report Date: 12/12/2024
Date Signed: 12/12/2024 01:49:46 PM

Document Has Been Signed on 12/12/2024 01:49 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:TO, PHUONG TRAMFACILITY NUMBER:
434412847
ADMINISTRATOR/
DIRECTOR:		TO, PHUONG TRAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 600-4553
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
12/12/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Phuong Tram ToTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On December 12, 2024, at 11:20 AM, Licensing Program Analyst's (LPA) Elimika Woods & Angela Luz met with licensee Phuong Tram To for an Unannounced 3 Year Required Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was the licensee's two fingerprint cleared assistants. All adults subject to criminal background review have obtained criminal record clearance. There were 11 children present during today’s inspection, eight preschool age children and three infants. The licensee stated that the facility operates from Monday to Friday 7:30 AM to 5:00 PM.

LPA toured the facility inside and out to conduct a Health and Safety inspection. This single-story home consists of four bedrooms, three baths, a living, kitchen, backyard, day-care room and attached one and a half garage. This home was clean and orderly, with (centralized) heating and ventilation for the safety and comfort.

The off-limits will be made inaccessible by closed and/or locked doors and visual supervision. LPA checked the cabinets in the on limit areas which includes the kitchen, bathroom, bedroom, next to day-care room and any other cabinets or drawers accessible to children in care and did not observe any hazardous materials or toxins accessible to children during today’s inspection. At 11:45 AM, LPA inspected the backyard area to make sure that there are no pools, hot tubs or any other bodies of water present that violates the childcare licensing laws and there were none, during today's inspection.

On- Limit areas are the: Hallway bathroom, day-care room next to kitchen, bedroom next to day-care room, backyard, and kitchen

Off- Limit areas are the: Three bedrooms near the hallway bathroom, living room, right side-yard gated area, and garage.

LPA tested the smoke detector in the day care and the carbon monoxide detector in the hallway and found them to be functioning properly. The facility has a fully charged 3A40BC fire extinguisher which meets standards established by the State Fire Marshal hanging on the kitchen wall. The licensee also has a first aid kit that she keeps in a cabinet in between the day-care room and the kitchen wall. The Isolation area of the home will be a section of the kitchen, away from other children in care.

See 809-C for continuance.
Chandra CharlesTELEPHONE: (510) 286-0966
Elimika WoodsTELEPHONE: 510-622-2550
DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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: TO, PHUONG TRAM
FACILITY NUMBER: 434412847
VISIT DATE: 12/12/2024
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This home has a fireplace that's block/screen to prevent access by children in the day-care room. LPA asked the licensee does she transports children and the licensee stated that she does not transport children. During the record review LPA's checked the Health Records of the licensee, staff, and children and found that the licensee is following the immunization laws which pertain to all childcare providers. LPA also obtained a current children's roster.

The Backyard area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. During today's inspection, there a large play structure with swings that’s anchored to the ground with cushioning underneath to absorb children falls. There are ample age-appropriate toys that appear to be safe and in good condition. There's an awning that provides shade to children at play and a loop tricycle/bicycle path for children to play on.

At 12:00 PM, LPA requested and reviewed the files of four (4) children in care and three (3) staff files. All children’s files contain Identification & Emergency Information, Parent's Rights, and Medical Consent forms and the staff file has the required Employee Rights and Health Screening forms. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 12/02/2024. The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires on 10/2026. The licensee has completed mandated reporter training 10/13/2023. Per licensee there are no weapons of any kind in the home. The licensee is in ratio today. All required forms are posted and visible for public review.

Effective August 1, 2003, California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail The licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.



See 809-C for continuance.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: 510-622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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: TO, PHUONG TRAM
FACILITY NUMBER: 434412847
VISIT DATE: 12/12/2024
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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.

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.

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.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Phuong Tram To, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Phuong Tram To.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: 510-622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC809 (FAS) - (06/04)
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