434416179-10-17-2019-07-CC-SCOS-BH2PHU-20191017112029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416179
Report Date: 10/16/2019
Date Signed: 10/17/2019 11:20:41 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:	THAN, KHANH		FACILITY NUMBER:	434416179
ADMINISTRATOR:	KHANH THAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 597-7816
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	14	CENSUS: 0	DATE:	10/16/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Than khank		TIME COMPLETED:	11:45 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 Analyst (LPA) Stephanie Collins conducted an announced Pre-Licensing inspection of the house today. LPA met with Applicant Khanh Than and explained the nature of todays visit. Present in home were the Applicants husband( VU LE) Applicants have applied for a license to operate as a Large Family Child Care Home with a maximum capacity of 14 at the address listed above .Applicant has over one year experiences working in the child care industry as a director of a child care facility. There are four adults who live in the home The licensee her husband (Vu LE), and two room mates ( May Tran) and Boloflynn Zoleta) A review of records on 09/18/2019 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 also reminded licensee of the applicable $100 civil penalty per person per day, minimum of $500 to a maximum of $3000 per person, 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. . A copy of the lease agreement is on file. A Fire Safety Inspection was conducted on 07/26/19. The house has been granted a Fire Clearance with the following comment: " "Approved for children to use living room as day-care area, dinning room area, downstairs bathroom. Complete backyard is fully fenced and approved for use by children. Off limit areas are as follows; all of 2nd floor, kitchen, garage and front-yard are off limits and not approved for use by children." LPA observed that the home has fully charged 3A,40BC fire extinguishers. and Smoke and Carbon Monoxide detectors. The home’s disaster plan of action was discussed along with the requirement for the home to conduct and document fire and disaster drills at least once every six months. LPA reminded Applicant that smoking is not allowed in Family Child Care Homes and baby walkers cannot be used for child in care and needs to be kept inaccessible. Days and hours of operation will be Monday through Friday 7:00 AM to 6:00 PM. Applicants has completed 16 hours of training on preventive health practices, which included pediatric cardiopulmonary resuscitation and pediatric first aid, and one hour on Child Care Nutrition. A copy of the certification is on file. Applicant and husband (VU LE) both have proof of immunity against Measles, Pertussis and TB. Both have chose to opted out of the Influenza vaccinations (statements on file). Licensee's Certification of Completion of the AB1207 Mandated Reporter Training is on file. . LPA informed Applicants that if they decide to not carry liability insurance for their Family Day Care, they must have file of affidavits regarding liability insurance signed by each parent of the children that will be enroll.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: THAN, KHANH	FACILITY NUMBER: 434416179
	VISIT DATE: 10/16/2019

NARRATIVE

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LPA also reviewed with Applicant the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, Licensing Forms etc.

LPA discussed the requirements of AB633 to Licensee and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC9224) and licensee understands the requirements. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 month

Incidental Medical Services were discussed with the licensee. The licensee will not be providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future she decided to provide any IMS services to a child in care. 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.

Applicant is encouraged to visit the department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc. LPA reviewed with Applicant the violations that would result in an immediate assessment of civil penalty in the amount of $500. LPA also discussed with Applicant about safe sleep practice for infants. LPA Collins and LPA Matos provided Applicant with a Family Child Care Home packet with updated Licensing forms and reviewed them with the Applicant.

No regulatory violations were observed during today's inspection. Exit Interview was conducted, where this report was reviewed with Applicant

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: THAN, KHANH	FACILITY NUMBER: 434416179
	VISIT DATE: 10/16/2019

NARRATIVE

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Applicant states there are no weapons. Cleaning products, medications, Sharp objects and other similar items are inaccessible to children. LPA reminded applicant that poisons need to be locked.

LPA reminded applicant that smoking, baby walkers, bouncers’, jumpers and similar items are not allowed in Family Child Care Homes (FCCH).

Applicant will use talking, redirection are forms of discipline. Applicant understands that children's personal rights should not be violated; including no corporal punishment. LPA discussed with Applicant methods of isolating sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, healthy beverage law, and requirements for Assistant Providers. Applicant understands that she has to be present during 80% of day care operating hours.

Applicant was informed that upon receipt of Completion of Mandated Reported Training for Husband (Vu LE) and Licensing Management's approval, a license for a Large Family Child Care Home will be granted and issued.

Exit interview was conducted, where this report was reviewed and discussed with Applicant.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019

LIC809 (FAS) - (06/04)

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