434414205-6-6-2024-07-CC-SCHN-D5YPS4-20240606113344

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414205
Report Date: 06/06/2024
Date Signed: 06/06/2024 11:33:54 AM

Document Has Been Signed on 06/06/2024 11:33 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 CC RO, 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: 3	DATE:	06/06/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Tra Thi Nguyen & Son Nhut Truong		TIME COMPLETED:	11:45 AM

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	Page 1. On 6/6/24 Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced annual inspection at the facility. LPA met with the licensees, Thi tra Nguyen and Son Nhut Truong, and explained the nature of today’s inspection. Present during today’s inspection were the licensees and 3 children in the facility. Days and hours of operation are Monday to Friday, 7:00am to 9:00pm. The adults that reside in the home are the licensees and their son. The licensee stated that their son had a rifle locked in safety box and that there was no ammunition. The licensees stated they owned the home. Observation LPA observed that required postings were posted. LPA, along with the licensee, Son Nhut Truong, toured the inside and outside of the home. The facility has a full charged fire extinguisher, 2A10BC. Carbon monoxide and smoke detectors are working properly. The off-limit areas in the facility were the second floor, kitchen, garage, and the shed in the backyard. All disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible. LPA observed that there are toys for children inside and outside of the house. LPA conducted CARE Tools for this annual inspection, which include Physical Plant, Care and Supervision, Facility Administration, Records, Staffing Ratio and Capacity, Personnel Rights for compliance with all licensing statutes, regulations, and interim licensing Standards, and results were documented on the tool. continue to page 2.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena Chin	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

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 4

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: NGUYEN, TRA THI & TRUONG, SON NHUT	FACILITY NUMBER: 434414205
	VISIT DATE: 06/06/2024

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

Page 2.

Records review
The Licensees have current CPR and First Aid certifications expiring 1/14/26. The licensees did not have child abuse training certificates. LPA reviewed the fire and disaster drills log which is to be done at least once every six months. The last drills were conducted on 4/26/24. LPA reviewed children’s files. LPA observed Notification of Parents’ Rights is in each child’s file. The immunization records were not maintained for C2.

During today’s inspection, all adults present or residing in the home have criminal record clearances required by the Department. 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.

Discussion

Supervision of children was discussed with Licensee, who understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options. Licensee states that she does not transport children via vehicle but she understands that children cannot be left in parked vehicles unattended at any time.

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-and-resources/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.

continue to page 3.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena Chin	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: NGUYEN, TRA THI & TRUONG, SON NHUT	FACILITY NUMBER: 434414205
	VISIT DATE: 06/06/2024

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

Page 3.

Discussion
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/.

The 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.

Deficiency
Regulatory violations were observed during today’s inspection and citations were issued.

Further questions
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Exit
During the exit interview, the Licensee, Son Nhut Truong, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
Exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were reviewed and discussed with the licensee, Son Nhut Truong.
Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena Chin	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 06/06/2024 11:33 AM - 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: NGUYEN, TRA THI & TRUONG, SON NHUT	FACILITY NUMBER: 434414205
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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
1 2 3 4	Based on record review)], the licensee did not comply with the section cited above. The licensees did not have child abuse training certificates, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/13/2024
	Plan of Correction
1 2 3 4	The licensees will send LPA the copies of the valid mandated reporter training certificates.

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. The immunization records were not maintained for C2, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/13/2024
	Plan of Correction
1 2 3 4	The licensees will send LPA the copy of immunization records for C2.

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: Gladys Kuizon	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena Chin	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4