434415066-7-15-2022-07-CC-DMAC-CGD28K-20220715171027

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415066
Report Date: 07/15/2022
Date Signed: 07/15/2022 05:11:29 PM

Document Has Been Signed on 07/15/2022 05:11 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	PHAN, DIANE		FACILITY NUMBER:	434415066
ADMINISTRATOR:	PHAN, DIANE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 857-5585
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY:	14	CENSUS: 9	DATE:	07/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Diane Phan		TIME COMPLETED:	04:10 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 Analysts (LPAs) Dung Mac and Araceli Almarez met with Diane Phan, Licensee, for an unannounced Required -1 year annual inspection. LPAs observed nine children (4 preschool and 5 school-age) and an adult assistant (Lily Trinh) in the home during today's inspection. Licensee owns the home and a copy of Control of Property is on file. Her two minor children also live in home. Licensee does not have liability insurance. Licensee issues the Affidavit Regarding Liability Insurance (LIC 282) form advising parents that she does not have liability insurance for her day-care. LPAs observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 7:15AM to 6:15PM. The adults residing in the home are Licensee and Licensee's spouse (Philip Nguyen). LPAs toured the indoor and outdoor areas of the home during today's inspection. The home is clean and safe for the day care children. There are safe and age appropriate toys and materials for the children in the home. No baby walker, bouncers, excer-saucers, jumpers, were observed during today’s inspection. There are no stairs inside the home. LPAs observed a screened fireplace. LPAs did not observe any wall heaters inside the home. Off limit areas inside the home: all 4 bedrooms, barricaded kitchen, and garage. Off limit areas outside the home: right side of the house and off-limit AC & shed area. Licensee states that she provides breakfast, snacks, and lunch to the day care children. Licensee states that she understands that any food brought from home needs to be labeled with each child's name and properly stored. Licensee states that sick children will be isolated in the dining room area. Licensee states she does not transport children. Report To Be Continued on Page #2

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PHAN, DIANE	FACILITY NUMBER: 434415066
	VISIT DATE: 07/15/2022

NARRATIVE

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LPAs observed a fully charged 3A40BC fire extinguisher and working smoke/carbon monoxide detectors. Licensee states that she does not have weapons in the home. Licensee has 2 small-sized pet dogs and they are kept in the off-limit bedroom during daycare hours. Per licensee, the dogs are up-to-date with vaccinations

All detergents, cleaning compounds. medications, and other similar items are stored inaccessible to children. Licensee states that there are no poisons in the home. Licensee states that she does not administer any medications to the day care children. Licensee has a first aid kit in the home which includes a touch less thermometer. Licensee states that nobody smokes and she understands that smoking is prohibited in the home.

LPAs observed the backyard is adequately fenced and no bodies of water. The area under and around the climbing structure has resilient materials (artificial grass) to absorb the falls. LPAs observed a locked storage shed and AC unit in the fenced off area.

LPAs reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Licensee has current First Aid/CPR certifications (expires 2/12/2024). Licensee has the required vaccines (MMR, Tdap, and flu - opt out) and is current with her Mandated Reporter Training (expires 12/29/2023). Licensee's adult assistant also has the required vaccines (MMR, Tdap, & flu - opt out) and is current with Mandated Reporter Training (expires 01/04/2024). LPAs reviewed nine children's files and two staff files. All files were complete with the required forms.

Supervision of children was discussed with the Licensee and she 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/ratio options and she understands that she cannot have more than 14 children present in the home without at least two qualified adults present.

Report To Be Continued on Page #3

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PHAN, DIANE	FACILITY NUMBER: 434415066
	VISIT DATE: 07/15/2022

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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/process

Exit interview conducted and report was reviewed with the Licensee, Diane Phan. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

LIC809 (FAS) - (06/04)

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