<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415162
Report Date: 10/29/2019
Date Signed: 10/29/2019 10:31:11 AM

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: 10DATE:
10/29/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ngan Phan, LicenseeTIME COMPLETED:
10:40 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
Licensing Program Analysts (LPAs) Mel Matos and Dung Mac met with Ngan Phan and Nguyen, Nguyen, Licensees, for an unannounced Plan of Correction inspection. LPAs also observed ten day care children (3 infants & 7 preschool) and two adult assistants, Minh Truong and Cuc Nguyen, in the home during today's inspection.

The Licensees were issued a "Type A" deficiency on August 14, 2019 per Section 102421 - Child's Records - of Title 22 regulations as a result of the family child care home operating out of ratio. LPAs Matos and Mac observed fourteen day are children (3 infants and 11 preschool) napping in the home during the inspection on August 14, 2019.

On 10/22/19, Licensees emailed LPA Mac the Weekly Schedule of children currently enrolled in the day care and the names of two children that were dropped so that the Licensees are in compliance with the ratio requirements of the large Family Child Care Home license. LPAs Matos and Mac notes that the Licensees were operating with the required ratio of the large Family Child Care Home license during today's inspection
(3 infants and 7 preschool children present).

The Licensees have completed the required Plan of Correction and the Type A deficiency noted above is thus cleared as of today's inspection. Today's report was also translated from English to Vietnamese by LPA Mac.

No deficiency was issued today. An exit interview was conducted. A Note of Site Visit was issued, posted near the front entrance to the home, and must be posted for 30 consecutive day.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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 1