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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700339
Report Date: 07/24/2024
Date Signed: 07/24/2024 12:25:06 PM

Document Has Been Signed on 07/24/2024 12:25 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/
DIRECTOR:		NGUYEN, HOAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 443-8188
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
07/24/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:46 AM
MET WITH:Hoa NguyenTIME VISIT/
INSPECTION COMPLETED:
12:23 PM
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On 7/24/2024 at 8:46am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Hoa “Lisa” Nguyen for an Unannounced Annual/Random Inspection. Present during the inspection was the Licensee, her adult daughter who serves as her helper, and nine (9) preschool age children. Licensee lives in the home with her husband, their adult daughter and minor son. Licensee’s home was toured for a health and safety inspection. The facility operates 8:00am – 5:30pm, Monday – Friday.

The facility is one of four buildings on the Licensee’s property which she owns. First, there is Licensees main home which consists of three bedrooms two bathrooms. 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 is the building in the back used for childcare. The childcare building consists of two rooms, Room one (1), Room two (2), and two bathrooms.

ON LIMITS AREA: childcare building, bedroom with attached bathroom at the end of the hallway of the main home (used for infants), deck area of the main home, and back yard of the childcare building
OFF LIMITS AREA: remaining areas of the main home, front yard, triplex rental property and office building
ISOLATION AREA: room two (2) of the childcare building




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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: NGUYEN, HOA
FACILITY NUMBER: 015700339
VISIT DATE: 07/24/2024
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The inside of the childcare building and home was observed to be neat, clean with ample age-appropriate materials for the children’s learning and play. All toxins, personal medication, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee does not provide food for the children. All children are required to bring their own food and snacks. All food that is brought from the children’s home was observed to be properly labeled and stored. All off limit areas in the home and building are made inaccessible with gates, and locks. Licensee stated she does not transport children, there is one (1) small dog in the main home that will not interact with the children and there are no firearms on the property.

There are two (2) 2A10BC fire extinguishers and a pull-down alarm in room two (2) of the childcare building. 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 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. Licensee uses cots for sleeping and the children provide their own bedding. There is one (1) crib in the home for infants sleeping. All napping equipment was observed to be clean and well maintained. Licensee uses child sized tables and chairs for mealtimes.

The backyard of the childcare building 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. There are two (2) sheds used for storage one is locked and the other is unlocked. LPA observed fourteen (14) spots in the backyard that sink down into shallow holes. LPA informed Licensee that although the holes are covered with artificial turf, the holes could be potential tripping hazards for the children. LPA and Licensee discussed methods to fill the holes. LPA did not observe any harmful bodies of water in or around the home. In the main home there is a large outside deck that has plenty of age-appropriate materials and three (3) small storage containers that are locked and inaccessible to the children. The play area is also fenced for extra safety.



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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 9
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: 07/24/2024
NARRATIVE
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The facility is operating within its licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid is complete and expires 4/15/2025. Licensee’s Mandated Reporter training is complete and expires 8/29/2025. LPA obtained the fire/disaster drill log. Fire/disaster drills have been conducted and recorded within the last six (6) months with the last drill logged 3/1/2024. All adults living and working in the home have obtained a criminal record clearance. All required forms are posted on the window of room one (1). LPA obtained a sample of the children’s files, her helpers file, and facility files. All files were complete.

No deficiencies were cited during LPAs inspection.

Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's authorized representatives, and to Community Care Licensing Division (CCLD) within 24 hours by phone. Within seven (7) days of the incident, Licensees must submit the Unusual Incident/Injury form (LIC 624B) to CCLD. Licensee was reminded that any structural changes or additions to the home must be reported to CCLD. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.



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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
Page: 3 of 9
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: 07/24/2024
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee Hoa Nguyen, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
Page: 4 of 9
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: 07/24/2024
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-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 the Licensee Hoa "Lisa" Nguyen.

















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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
Page: 5 of 9