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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413894
Report Date: 03/21/2023
Date Signed: 03/23/2023 09:11:24 AM


Document Has Been Signed on 03/23/2023 09:11 AM - 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:NGUYEN,NGHIA HIEUFACILITY NUMBER:
434413894
ADMINISTRATOR:NGUYEN,NGHIA HIEUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 401-9729
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY:14CENSUS: 9DATE:
03/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Nghia Hieu NguyenTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA), Farida Raja and Licensing Program Manager (LPM), Gladys Kuizon met with Licensee, Nghia Nguyen for a case management inspection to deliver the amended report for an inspection conducted on 03/01/2023.

On arrival, LPAs observed 9 children including 4 infants and 5 preschoolers with one assistant (Xuan Hoa Nguyen) and licensee.

LPA reviewed the amended report with Licensee and discussed the deficiencies corrected. LPA also reviewed a random selection of children’s file to check for a signed ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) as per plan of correction after previous inspection. LPA obtained licensee’s signature on the amended LIC 809 and 809D pages and issued a Notice of Site Visit for today’s case management inspection.

As a result of today's inspection, no deficiencies were cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) -56-5850
LICENSING EVALUATOR NAME: Farida RajaTELEPHONE: (916) 566-5850
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2023
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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