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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415325
Report Date: 11/09/2022
Date Signed: 11/09/2022 01:49:19 PM


Document Has Been Signed on 11/09/2022 01:49 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:HUYNH, TINAFACILITY NUMBER:
434415325
ADMINISTRATOR:HUYNH, TINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4086878099
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 8DATE:
11/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Tina Huynh TIME COMPLETED:
01:56 PM
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On 11/9/2022 Licensing Program Analyst Stephanie Collins conducted an annual random inspection. Due to COVID- 19 precautionary measures were taken, LPA met with Licensee, Tina Huynh and explained the nature of today's inspection. Present during the inspection was the licensee and assistant Nguyen Thanh. Licensee states that there is currently her husband ( Dung, Tran) and their two minor children current residing in the home.
Days and hours of operation are Monday thru Friday from 8:30 AM to 5:00 PM.
There were eight (8) children present during the inspection.

Licensee Tina Huynh 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.


Physical Plant: This is a single home dwelling which consists 3 bedrooms and 2 bathrooms. LPA inspected the indoor and outdoor areas of the home today. Per licensee off limit areas in the home are as follows; All bedrooms, kitchen and. Off limit areas outside the home are as follows: right side of yard and aa fenced off garden LPA observed a fenced backyard and no bodies of water. LPA observed a storage shed in the fenced off area
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2022
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HUYNH, TINA
FACILITY NUMBER: 434415325
VISIT DATE: 11/09/2022
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The home was found to be clean and orderly with ventilation and central heating for safety and comfort. There were safe toys, play equipment and materials observed for children. LPA did not observe any hazards inside of the home. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock. Licensee states that there are no weapons in the home. LPA observed designated area for Medication storage to be inaccessible to children in care
LPA observed and inspected sleeping equipment. Each child has their individual bedding and is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants.

Facility Records: The following personnel records were requested and reviewed: CPR and First Aid- (Licensee renew date (8/23), Proof of immunization- ( MMR & Tdap vaccinations), as well as opt out for flu vaccine. A current roster. homeowner’s insurance or Affidavit, LIC 508 Criminal Record Statement , LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to report Child Abuse, Mandated Reporter Training (Licensee valid through 1/2024) both understand this must be renewed every two years.

Children Records: a percentage of children’s records were reviewed for the following documents; current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file, LIC 282 Affidavit regarding liability insurance, LIC 700 Identification and Emergency information, LIC 627 Consent for Emergency Medial Treatment,

incidental Medical Services (IMS) policy was discussed. Per Licensee there are currently no children enrolled who required IMS. 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

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HUYNH, TINA
FACILITY NUMBER: 434415325
VISIT DATE: 11/09/2022
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LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was review. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. A review of PIN 20-24-CCP Recently approved Safe Sleep Regulations in Effect was discuss and a copy was provided to the Licensee during this inspection.

Fire and Disaster Safety: LPA observed a working smoke/carbon monoxide detector, 3A40BC fire extinguisher. LPA did not observe any heaters in the home. LPA observed observed a screened fireplace Fire disaster/earthquake drills last log10/13/2022.

Supervision: Supervision of the children was observed; Licensee understands the following: A cleared adult must be present in the home during day care hours. The children must be supervised at all times. The capacity options and ratio requirements. Licensee understands not to leave children in the car unattended. The Licensee states that there is no transporting of children currently.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee.

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.

A notice of site visit was given and must remain posted for 30 days.

Exit Interview

Exit interview conducted and report was reviewed with the licensee [or facility representative] (include name). \

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
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