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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414205
Report Date: 05/29/2019
Date Signed: 05/29/2019 12:11:52 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 NHUTFACILITY NUMBER:
434414205
ADMINISTRATOR:NGUYEN, TRA THIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 386-2045
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY:14CENSUS: 9DATE:
05/29/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Tra Nguyen TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced inspection of the Family Child Care Home. LPA met with Licensee Tra Nguyen and explained to her that the purpose of the inspection is to verify that the repeated Type A violation observed during LPA's inspection on 05/21/2019 is corrected.

On 05/03/19 Licensee was cited for not complying with capacity and staffing requirement. On 05/21/19 Licensee was cited again for repeating the same violation. That is, during both inspections, LPA observed that Licensee was the only person present in the home to provide care and supervision when she is required to have an assistant provider present due to the number and age of the children in care at the time.

Based on today's unannounced inspection visit, LPA determined that the violations cited on 05/03/19 and 05/21/19 are corrected. Present in the home were nine children, of whom one was infant age. Licensee and Assistant Provider Tien Le were present to ensure compliance with staffing requirement. Per Tien Le and Licensee, Tien Le now works Monday through Friday from 09:00 AM to 04:00 PM.

Therefore, a "Letter of Deficiency Citations Cleared" was issued and given to Licensee at the conclusion of the visit. Exit Interview was conducted, where this report was reviewed and discussed with Licensee in English and Vietnamese.

A NOTICE OF SITE VISIT WAS 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 KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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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