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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416713
Report Date: 04/27/2022
Date Signed: 04/27/2022 03:45:59 PM


Document Has Been Signed on 04/27/2022 03:45 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:NGO, QUANGFACILITY NUMBER:
434416713
ADMINISTRATOR:QUANG, NGOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 612-8815
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:14CENSUS: 1DATE:
04/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Quang NgoTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Licensee Quang Ngo and explained the reason for the inspection. Present during today's inspection were Licensee, his wife, and his own child.

Licensee stated that he is going to be closing his family child care home. Licensee will submit a written letter and license to Licensing. LPA toured the inside of the home.

No deficiencies were cited as a result of this inspection. Exit interview conducted and report was reviewed with the licensee Ngo Quang. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2022
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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