015700339-4-6-2023-52-CC-MPRE-CQMPXG-20230406114218

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700339
Report Date: 04/06/2023
Date Signed: 04/06/2023 11:42:33 AM

Document Has Been Signed on 04/06/2023 11:42 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	NGUYEN, HOA		FACILITY NUMBER:	015700339
ADMINISTRATOR:	NGUYEN, HOA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 443-8188
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 15	CENSUS: 12	DATE:	04/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Hoa Nguyen		TIME COMPLETED:	11:40 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	On 4/6/2023 at 9:07am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Hoa “Lisa” Nguyen for an Unannounced 1-Year Inspection. Present during the inspection was the Licensee, her husband, Denny Nguyen, who is her helper and twelve (12) preschool age children. Licensee’s Assistant Rogia Omar arrived around 9:30am. Licensee lives in the residential home on the property with her husband and two (2) minor children, age seventeen (17) and nine (9). Licensee’s home was toured for a health and safety inspection. The facility operates from 8:00am – 5:30pm Monday – Friday. The facility is one of four buildings on the Licensee’s property. First, there is the “off limits” three bedroom two bathroom home that the Licensee lives in. Second, an “off-limits” triplex rental property. Unit one is a two bedroom, two bathroom, unit two is a two bedroom, one bathroom, and unit three is one bedroom, one bathroom. Third, a building marked “office” but is currently being used a storage. Fourth, the back building used for childcare. The childcare building consists of two rooms, Room one (1), Room two (2), and two bathrooms. ON LIMITS AREA: Childcare Building and Back Yard OFF LIMITS AREA: Residential Home, Front Yard, Triplex Rental Property and Office Building ISOLATION AREA: Room two (2) of the Childcare Building Licensee follows a Montessori curriculum and only provides care for preschool age children. The inside of the building was observed to be neat, clean with ample age appropriate materials for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee stated that all children bring food from home and she does not supply food. All food that is brought from the children’s home is properly labeled and stored. Licensee does not transport children. There is one (1) dog that lives, and stays, in the Licensee’s home, and there are no firearms on the property.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: NGUYEN, HOA	FACILITY NUMBER: 015700339
	VISIT DATE: 04/06/2023

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
26
27
28
29
30
31
32

There is a working smoke detector in both rooms of the childcare building. There is one working smoke/carbon monoxide detector above the main door. There are two (2) 2A10BC fire extinguishers and a pull-down alarm. There is a wall heater across from the bathroom in room two (2) that is barricaded and inaccessible to the children in care. The childcare building is equipped with plenty of windows for proper ventilation as well. LPA did not observe any harmful bodies of water in or around the home.

The backyard is fully fenced with ample materials for the children. There are two play structures that are anchored into the ground for safety and other large play materials. All gates are locked and there is one (1) shed that is locked making it inaccessible to the children in care.

Licensee is operating within their licensed capacity and is in ratio. Licensee’s Health and Safety training with lead poisoning component has been completed and Pediatric CPR and First Aid training is complete and expires on 8/21/2023. Licensee’s Mandated Reporter training is complete and expires 7/24/2023. LPA obtained the fire/disaster drill log with the last drill logged 3/1/2023. All adults living and working on the property have obtained a criminal record clearance. All required forms are posted on the window of the childcare building. LPA obtained a sample of the children’s files, assistants file and facility roster. All files were complete.

Licensee was reminded that California Law requires Licensee to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.
Licensee was reminded that EMSA approved Pediatric CPR & First Aid training and Mandated Reporter training ("Child Care Providers") must be completed every two (2) years.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: NGUYEN, HOA	FACILITY NUMBER: 015700339
	VISIT DATE: 04/06/2023

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
26
27
28
29
30
31
32

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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/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-and-resources/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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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.
Exit interview conducted and report was reviewed with Licensee Hoa Nguyen.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

Page: 5 of 5