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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415162
Report Date: 02/11/2022
Date Signed: 02/11/2022 04:00:55 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: 11DATE:
02/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:53 AM
MET WITH:Nguyen NguyenTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Janette Cruz arrived at the facility for an unannounced Required 1 Year inspection and was greeted and granted access to the home by Licensee's assistant, Minh Truong. Licensee, Nguyen "Kevin" Nguyen arrived within 10 minutes and met with LPA. LPA informed Licensee of today's purpose of visit. LPA also observed Thi Hoang, Licensee's other care assistant, three infants and eight preschool day care children in the home during today's inspection. The Licensee was operating within his capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 8:00 AM to 6:00 PM. Licensee states that aside from him, his uncle, Cuong Le and his uncle's wife, Lan Nguyen are the adults residing in the home. There are no active waivers or exceptions for this facility. Licensee has current CPR and First Aid certifications (expiration: 09/18/2022).

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 05/14/2021. Licensee has the required vaccinations (MMR, Tdap, & flu) and is current with the Mandated Reporter Training for Child Care Workers (expiration: 09/23/2023). LPA reviewed nine children's files which were complete with the required forms.

Based on staff interview conducted, Licensee need more information regarding Safe Sleep regulations. LPA provided a technical advisory regarding safe sleep. LPA discussed the safe sleep regulations with the 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 the 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.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PHAN, NGAN & NGUYEN, NGUYEN
FACILITY NUMBER: 434415162
VISIT DATE: 02/11/2022
NARRATIVE
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LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Licensee states that a child will be isolated in the front living room (study area) of the home if necessary due to illness or communicable disease.

LPA observed the indoor area of the home is clean, orderly, and safe for the day care children. LPA also observed a screened fireplace. There are no open face heater units or stairs inside the home. The Licensee has the Living room, Family room, Kitchen and Bathroom 1 primarily used for the day care. Off limit areas in the home: Attached garage/home office, four bedrooms and one bathroom, Off limit areas outside the home: left side of the backyard.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensee states that he does not have any weapons in the home. LPA observed Licensee has pets in the home : seven dogs that are kept fenced not accessible to children. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. All poisons are stored in the locked storage located in the backyard. The Licensee states that he currently does not administer medication to the day care children.

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.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PHAN, NGAN & NGUYEN, NGUYEN
FACILITY NUMBER: 434415162
VISIT DATE: 02/11/2022
NARRATIVE
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Supervision of children was discussed with Licensee and he understands that he must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands his capacity options and he understands that he cannot have more than 14 children in the home at any time without a fully qualified adult present. Licensee states that he does not transport any day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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.

During this inspection, LPA also addressed the request of Licensee to remove, Ngan Phan, from current license. Licensee states that Ngan Phan, no longer lives in the home.


Exit interview conducted and report was reviewed with the Licensee, Nguyen "Kevin" Nguyen. As a result of todays inspection, deficiencies were cited on the following page.


A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 02/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above, fire drill was not conducted more than six months ago which poses potential health, safety risk to persons in care.
POC Due Date: 02/25/2022
Plan of Correction
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Licensee will submit to LPA a documentation of fire drill has been conducted by POC due date.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. Two staff who were left to supervise the children did not have current Pediatric First Aid and CPR training certificate which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/25/2022
Plan of Correction
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Licensee will submit Pediatric First Aid and CPR Training certificate of two care assistants by POC due date .
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) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4