<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700339
Report Date: 01/29/2024
Date Signed: 01/29/2024 01:54:41 PM

Document Has Been Signed on 01/29/2024 01:54 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:NGUYEN, HOAFACILITY NUMBER:
015700339
ADMINISTRATOR:NGUYEN, HOAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 443-8188
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
01/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Hoa "Lisa" NguyenTIME COMPLETED:
01:53 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
On 1/29/2024 at 1:20pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Hoa "Lisa" Nguyen for a Case Management Inspection. Licensee is requesting to add the bedroom and bathroom at the end of the hallway in the main house on the property as an on-limit area. Licensee stated this area will be used for infants. The inside of the room is observed to be neat, clean, with ample age appropriate materials for the children. All hazards were observed to be in inaccessible areas.

There is a large outside deck that has plenty of materials and three (3) small storage container that are locked and inaccessible to the children. The play area is also fenced for extra safety.

LPA Pringle has granted the usage of the additional room.

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

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

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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 1