434416713-5-20-2021-07-CC-SYIP-C37KSM-20210520080942

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416713
Report Date: 05/19/2021
Date Signed: 05/20/2021 08:10:03 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:	NGO, QUANG		FACILITY NUMBER:	434416713
ADMINISTRATOR:	QUANG, NGO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(669) 210-3077
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	14	CENSUS: 0	DATE:	05/19/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Quang Ngo		TIME COMPLETED:	05:36 PM

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) Samantha Yip conducted an announced Pre-Licensing inspection. Due to COVID-19 and shelter in place, a tele-inspection was conducted via Facetime. LPA met with Applicant Quang Ngo and explained the reason for the inspection. The purpose of the inspection is Applicant is applying for a change of location and an increase in capacity from a small Family Child Care Home (FCCH) to a large FCCH. Applicant was previous licensed at 2158 Lincoln Avenue, Alameda 94501 from 07/03/2014 to 02/24/2021 as a small FCCH. Therefore, Applicant has over one year of experience to apply for a large FCCH. Present during today's inspection were Applicant and his spouse. LPA informed Applicant that a copy of this report will be emailed to her. Applicant's response within 24 hours to email will serve as acknowledgement that report was received. There is an area for required postings. Applicant plans on obtaining daycare insurance. Applicant understand that he needs to use the Affidavit Regarding Liability Insurance to inform parents if he do not have a daycare insurance. The hours of operation are Monday through Saturday 7AM to 6PM. There is a working phone in the home, which is (408) 612-8815. Applicant guided LPA on a tour of the home via Facetime. A fire clearance was granted on 04/06/2021. The off-limit areas of the home are the living room, kitchen, bathroom next to the living room, 2 bedrooms, garage, and the left side of the backyard. There is a fountain in the front yard, which was turned off. Applicant stated that he will submit a waiver request if he wants to use it. There is a fireplace in the home, which is barricaded. All cleaning supplies and sharp objects were inaccessible to children. LPA observed that there -------------------CONTINUES ON 809 DATED 05/19/2021 PAGE 2----------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021

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: NGO, QUANG	FACILITY NUMBER: 434416713
	VISIT DATE: 05/19/2021

NARRATIVE

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-----------------CONTINUATION OF 809 DATED 05/19/2021 PAGE 1-----------------------------

is sufficient age-appropriate equipment and toys. There were no baby walkers observed during today's inspection. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Applicant understand that fire/disaster drills need to be conducted every six (6) months and documented. Applicant stated that there are no firearms, such as weapons, stored in the home.

Applicants plans on using the backyard for the children, which is fenced. LPA reminded Applicant to ensure that the shed in the backyard is locked at all times. There were no bodies of water observed during today's inspection.

Applicant does not plan on transporting children at this time, but understands that children cannot be left alone and unattended in parked vehicles. The form of discipline plan on using is time-out. Applicant understands that time-outs should not be more than a minute per age. Applicant also understands that children's personal rights should not be violated; including no corporal punishment.

Applicant does not plan on providing Incidental Medical Service at this time. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan of Operation that includes 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.

LPA emailed Applicant updated Family Child Care forms packet and COVID-19 resources. Department website: www. ccld.ca.gov provided to the Applicant. LPA discussed with Applicant about safe sleep regulations.

-----------------------CONTINUES ON 809 DATED 05/19/2021 PAGE 3----------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021

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: NGO, QUANG	FACILITY NUMBER: 434416713
	VISIT DATE: 05/19/2021

NARRATIVE

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-----------------CONTINUATION OF 809 DATED 05/19/2021 PAGE 2--------------------------
LPA also discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

When Licensee have more than 12 and up to 14 children in the home, Licensee must notify the parent using the form LIC9150 “Parent Notification Additional Children in Care." LPA reminded Licensee that when Licensee does not have a Helper, Licensee can only care for up to 8 children at any one time in the home.

Applicant has a valid CPR/1st Aid, which expires on 01/09/2023. Applicant's Preventive Health, Safety, and Nutrition certificate and immunization records for measles and pertussis are on file. Applicant stated that he will sent proof of influenza. Applicant has completed the Mandated Reporter training on 02/19/2020. LPA reminded Applicant that Mandated Reporter training requires renewal every two years.

The adults living in the home are Applicant and his spouse. All adults have cleared criminal record, child abuse index clearance, and TB clearance. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, 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.

LPA conducted an exit interview with Applicant and LPA advised Applicant upon approval of Licensing Management, a license for a Large Family Child Care Home will be granted and issued to Applicant.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021

LIC809 (FAS) - (06/04)

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