434415350-2-10-2025-07-CC-AYAG-DDRQKB-20250210111404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415350
Report Date: 02/10/2025
Date Signed: 02/10/2025 11:14:47 AM

Document Has Been Signed on 02/10/2025 11:14 AM - 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	NGUYEN, TRANG		FACILITY NUMBER:	434415350
ADMINISTRATOR/ DIRECTOR:	NGUYEN, TRANG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 646-1705
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 12	DATE:	02/10/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Trang Nguyen		TIME VISIT/ INSPECTION COMPLETED:	11:30 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	At 8:30 AM, Licensing Program Analyst (LPA) Andy Yang met with Licensee, Trang Nguyen, to conduct an unannounced annual random inspection. Present for this inspection were Licensee, (1) staff, (12) children (2 infants & 10 preschool age). The home was toured to conduct a Health and Safety Inspection. Days and hours of operation are from Monday to Friday 8:00 AM to 6:00 PM. The ages of the children to be served are from 0 to 7 years old. The home is single family home. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are room 1 (play area), living room, dining room, bathroom 1, and backyard. The OFF LIMIT AREAS are garage, room 2, room 3, bathroom 2, and room 4 are inaccessible by closed and/or locked doors and with visual supervision. The ISOLATION AREA is room 1 (play area). The outdoor play area is free from defects or dangerous conditions and is fenced. There have been no changes from the areas previously identified as OFF LIMITS or alterations to existing building or grounds. There are ample age-appropriate toys that appear to be safe and in good condition. LPA observed the fireplace is barricaded. There are no bodies of water. All hazardous materials and toxins are kept out of the reach of children. Licensee states that any poisons are stored in kitchen and garage which are OFF LIMITS. LPA reminded Licensee that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. *Continue Page 2*

Belinda Devall	TELEPHONE: (408) 324-2148
Andy Yang	TELEPHONE: (408) 497-3126
	DATE: 02/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN, TRANG	FACILITY NUMBER: 434415350
	VISIT DATE: 02/10/2025

NARRATIVE

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The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The Licensee CPR and First Aid certificate is current and expires 3/2025. Licensee completed the Mandated Reporter Training for Child Care Providers on 12/09/2024 (expires on 12/2026) and a copy of the certification is on file. Licensee was reminded of Mandated Reporter Training (AB1207) and CPR/First aid certifications needs to be renewed every two years. A copy of the licensee’s immunization is on file. Per Licensee, there are no firearms in the home. The Licensee conducts and documents fire and disaster drills every six months. Last disaster drill was conducted on 8/30/2024. Personnel records are available for review and contain all required forms. Child’s records are available for review. LPA inspected (5) children's file, and three were missing Affidavit Regarding Liability Insurance LIC 282. LPA reminded that children's file must contain all required forms. All REQUIRED forms are posted and visible for public review.

Licensee has enrolled (2) infants who are over the age of 1 year old. LPA inspected children's file for C1 and C2, which were missing the 15 minute sleep log. LPA reminded, per Safe Sleep Regulation PIN-20-24-CCP, that providers must check on sleeping infants every 15 minutes and document their condition to check for signs of distress, which includes, but not limited to labored breathing, flushed skin color, increase in body temperature, and restlessness.

Forms of discipline to be used by Licensee are redirecting and talking with the child. Licensee understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, children are treated with dignity, receive safe, healthful, and comfortable accommodations, interference with eating, intimidation, or other actions of a punitive nature.

Also, discussed with the Licensee was isolation of sick children, supervision of children, staffing ratio and capacity, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute.

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SUPERVISOR'S NAME: Belinda Devall	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Andy Yang	TELEPHONE: (408) 497-3126
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN, TRANG	FACILITY NUMBER: 434415350
	VISIT DATE: 02/10/2025

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, Trang Nguyen, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Megan's Law was checked on 2/04/2025.

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SUPERVISOR'S NAME: Belinda Devall	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Andy Yang	TELEPHONE: (408) 497-3126
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN, TRANG	FACILITY NUMBER: 434415350
	VISIT DATE: 02/10/2025

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

There were No deficiency issued, (1) Technical Violation, and (1) Technical Assistance were issued during today's inspection. Appeal Right's was provided.

Technical Violation - Licensee shall check and document 15 minute sleep log for infants
Technical Advisory - Licensee shall have Affidavit Regarding Liability Insurance LIC 282 to be signed by parents for child C1, C2, & C5

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

Exit interview conducted and report was reviewed with the Licensee, Trang Nguyen.

SUPERVISOR'S NAME: Belinda Devall	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Andy Yang	TELEPHONE: (408) 497-3126
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025

LIC809 (FAS) - (06/04)

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