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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415162
Report Date: 10/22/2019
Date Signed: 10/22/2019 03:45:13 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:PHAN, NGAN & NGUYEN, NGUYENFACILITY NUMBER:
434415162
ADMINISTRATOR:NGAN & NGUYENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 226-0398
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 14DATE:
10/22/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Ngan Phan & Nguyen NguyenTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Mel Matos and Dung Mac met with Ngan Phan and Nguyen Nguyen, Licensees, for an unannounced case management inspection. LPAs observed 14 napping day care children (3 infants & 11 preschool ) upon arrival to the home today. LPAs note that all 14 children were still present in the home at the conclusion of today's inspection.

The Licensees were issued a "Type B" deficiency on August 14, 2019 per Section 102421 - Child's Records - of Title 22 regulations as a result of an unannounced annual/random inspection in which LPAs reviewed thirteen children's files and observed that all 13 files were incomplete & missing required forms. LPAs reviewed 16 children's files during today's inspection and note that all files were complete with the required forms. The Licensees therefore have cleared the deficiency issued on August 14, 2019.

LPAs note that the Licensees were operating out of ratio during today's inspection since they had more than 12 children present (3 infants & 11 preschool) and none of the children were school age. The Licensees own children, ages 9 & 7 years of age, were not present in the home during today's inspection. The following "Type A" deficiency is thus noted on the attached page (809-D). An exit interview was conducted with the Licensees and appeal rights provided to them prior to the conclusion of today's inspection. Today's report was also translated from English to Vietnamese by LPA Mac.

A notice of site visit was issued and posted near the facility entrance along with the Type "A" citation and both notices must remain posted for 30 consecutive days. The Licensees must provide copies of this report to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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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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, NGAN & NGUYEN, NGUYEN
FACILITY NUMBER: 434415162
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2019
Section Cited

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Staffing Ratio & Capacity: For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:
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More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met. This requirement is not met as evidenced by: LPAs Matos & Mac observed 14 napping day care children (3 infants & 11 preschool) in the home during today's inspection.
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The Plan of Correction shall include weekly schedule of all children enrolled. This presents an immediate risk to the health/safety of children in care. The Licensee shall provide a copy of today's report to all parents/guardians of enrolled/newly enrolled children along with the LIC 9224 for the next 12 months.

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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: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2019
LIC809 (FAS) - (06/04)
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