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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415350
Report Date: 08/08/2019
Date Signed: 08/08/2019 10:47:17 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:NGUYEN, TRANGFACILITY NUMBER:
434415350
ADMINISTRATOR:NGUYEN, TRANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 646-1705
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 8DATE:
08/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Nguyen, TrangTIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Almaraz, Araceli conducted an annual random inspection. LPA met with Licensee, Nguyen, Trang and explained the nature of today's inspection. Present during the inspection was the licensee and assistant Nguyen, Diem. There were eight children present, one infant, six toddlers and one kindergarten age. The hours of operation of the day-care are 8 AM to 6 PM, Monday through Friday. There are three adults residing in the home: Licensee, spouse Vu, Kevin and father Nguyen, Hoi. Licensee has CPR and First Aid, which has an expiration date of 09/2019. Assistant has CPR and First Aid, which has an expiration date of 10/2019. LPA reviewed eight children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. LPA observed that the Licensee and assistant have record of MMR & Tdap vaccinations as well for the flu vaccine. LPA and licensee discussed information on finding current immunization requirements for day care children. LPA referred licensee to Family Child Care Home regulations, Immunization's section 102418 for further information on required immunization's.

LPA observed a working smoke/carbon monoxide detector, 3A40BC fire extinguisher and no bodies of water were observed. LPA did not observe any heaters in the home. LPA observed a screened fireplace. LPA inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows: Master bedroom/bathroom, two bedrooms, kitchen and garage. The hallway and kitchen areas are gated to prevent direct access to the children in care. LPA and licensee discussed getting child proof door safety covers for the off limits doors since the bathroom the children use is in the gated area. This area is safety compliant.
Report Continued on Page 2*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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 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: NGUYEN, TRANG
FACILITY NUMBER: 434415350
VISIT DATE: 08/08/2019
NARRATIVE
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 Off limit areas outside the home are as follows: None. There is an air-conditioning unit in the back yard. LPA and licensee discussed air conditioning unit that has access to the children in care. Licensee understands the potential risk of the unit and would like to minimize any risks it may cause. The front yard is safety complaint and backyard is fully fenced.

Medication, cleaning products and similar items are stored inaccessible to children. Poisons shall be locked. LPA observed a current roster, a current fire disaster/earthquake drills last log 08/2019. Licensee states that there are no weapons in the home. Licensee has no pets. Licensee has no day care insurance. Licensee has not completed Mandated Reporter Training, licensee understands training is to be completed every two years.

Supervision of the children was discussed; the Licensee understands a cleared adult must be present in the home during day care hours. Licensees understand that the children must be supervised at all times. The Licensee understands 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.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee.

Report Continued on Page 3*****



SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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: NGUYEN, TRANG
FACILITY NUMBER: 434415350
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2019
Section Cited
CCR
102417(g)
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Operation of a Family Child Care Home :The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: This requirement was not met as evidenced by LPA observed licensee failed to meet this requirement by an air conditioning unit that does not prevent to the children in care.
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Licensee will barricade air conditioning unit and send proof of correction via fax, email, mail or text photo to LPA on or before 08/22/2019. If needed LPA will return to confirm barricade is suffiicient to prevent access to the chidren in care.
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This poses a potential risk to the health and safety to the children in care.
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Type B
09/23/2019
Section Cited
HSC
1596.8662(b)(1)
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Health and Safety: On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Licensee will send proof of completion to LPA for Mandated Reporter Training for licensee and assistant on or before 09/23/2019, via fax, mail, text photo or email..
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Thsi requirement was not met as evidenced by LPA observed licensee failed to provide proof of completion of Mandated Reporter Training. This poses a potential risk to the health and safety to the children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
LIC809 (FAS) - (06/04)
Page: 4 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: NGUYEN, TRANG
FACILITY NUMBER: 434415350
VISIT DATE: 08/08/2019
NARRATIVE
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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

A review of staff records on 08/05/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.



There are two Type B deficiencies during today's inspection.

The following Type B deficiencies noted on the attached page (809-D): LPA conducted an exit interview with the Appeal rights provided to the Licensee prior to the conclusion of today's inspection.

NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 DAYS.

Report Continued from Page 2*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4