434414205-5-21-2019-07-CC-TDON-BCDTF3-20190521144052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414205
Report Date: 05/21/2019
Date Signed: 05/21/2019 02:40:58 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:	NGUYEN, TRA THI & TRUONG, SON NHUT		FACILITY NUMBER:	434414205
ADMINISTRATOR:	NGUYEN, TRA THI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 386-2045
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY:	14	CENSUS: 10	DATE:	05/21/2019
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Tra Nguyen and Son Truong		TIME COMPLETED:	02:45 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) Tuoc Doan conducted an unannounced inspection of the Family Child Care Home. LPA met with Licensee Tra Nguyen initially and explained to her that the purpose of the inspection was to verify that the two Type A Violations and five Type B Violations observed during LPA's Annual Inspection of the Day Care Home on 05/03/19 have been corrected. LPA verified that the five Type B violations regarding missing required records are corrected. The Type A violation regarding accessible cleaning compounds, sharps, and other items which could pose a danger to children is corrected. The remaining Type A violation is in regards to staffing/capacity requirement. When LPA entered the home on 05/03/19, LPA observed that Licensee Tra Nguyen was by herself and caring for 8 children. None of the 8 children were enrolled in school and none were at least 6 years old. Therefore, Licensee by herself can only care for a maximum of six children. Licensees had submitted a plan of correction to Licensing Office stating that they will ensure that there is an two care providers present in the home with the children. When LPA entered the home today, 05/21/19, LPA observed that Licensee Tra Nguyen was again by herself caring for 10 children. None of the 10 children present were attending school or at least 6 years old. Licensee's Assistant Provider Tien Le arrived at the home after LPA arrived as she is scheduled to work starting at 01:30 PM. Licensee Son Truong arrived after Tien Le. LPA again explained to them that given the age of the children, Licensee Tra Nguyen cannot care for more than six children in the home when she is by herself.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN, TRA THI & TRUONG, SON NHUT	FACILITY NUMBER: 434414205
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/21/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/22/2019 Section Cited CCR 102416.5(e)	1 2 3 4 5 6 7	STAFFING RATIO AND CAPACITY. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Assistant Provider Tien Le and Licensee Son Truong came to the day care home approximately 15 minutes after LPA arrived. BY POC DUE DATE, 05/22/19, both Licensees will submit to Licensing Office a plan of action detailing how Licensees will ensure that they
	8 9 10 11 12 13 14	When LPA entered the home, Licensee Tra was by herself caring for 10 children, but based on the age of the children present she can care for up to 6 children. This poses an immediate risk to the health & safety of children. $250 Civil Penalty assessed for repeating the same violation cited on 05/03/19.	8 9 10 11 12 13 14	comply with the staffing ratio and capacity requirement.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN, TRA THI & TRUONG, SON NHUT	FACILITY NUMBER: 434414205
	VISIT DATE: 05/21/2019

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
26
27
28
29
30
31
32

Based on today's unannounced inspection of the home, LPA found that Licensees had violated Title 22 Regulations Section 102416.5(e) STAFFING RATIO AND CAPACITY again within a 12 month period.

Therefore, a Type A citations was issued and civil penalty in the amount of $250 was assessed for repeating the same violation within a 12 months period. The previous violation was cited on 5/03/2019.

Exit interviewed was conducted, where this report, the citation, plan of correction, civil penalty assessment, and appeal rights were reviewed and discussed with both Licensees in English and Vietnamese.

Due to the issuance of a Type A Citation during today's inspection, a copy of this Licensing Report must be given to each existing parent and to the parent of children who are enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and be kept in each child's file.

This report, a copy of the LIC 9224 form, and the Appeal procedure were provided to Licensees at the conclusion of the inspection.

A NOTICE OF SITE VISIT and THIS LICENSING REPORT were issued and must be POSTED on or adjacent to the interior side of the main door into the facility FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3