304312159-9-26-2023-06-CC-CNGN-CW2PK5-20230926112233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304312159
Report Date: 09/26/2023
Date Signed: 09/26/2023 11:22:36 AM

Document Has Been Signed on 09/26/2023 11:22 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	VU, CHI		FACILITY NUMBER:	304312159
ADMINISTRATOR:	VU, CHI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 836-1765
CITY:	IRVINE	STATE: CA	ZIP CODE:	92606
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	09/26/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Licensee, Chi Vu		TIME COMPLETED:	12:00 PM

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A case management inspection was conducted today by Licensing Program Analyst (LPA), Cindy Nguyen who met with the licensee, Chi Vu. A self-report incident was received at the regional office on 09/19/23 which stated that Child #1 (C1) parent texted the facility at 6:28pm on 09/18/2023 stated that C1 was inappropriately touched by another child at the facility. Parent of C1 stated the incident happened on Monday 09/18/23 however Child #2 (C2) wasn’t at the facility. Parent of C1 than stated it occurred last week and that it occurred more than one time.

Present during today’s inspection was the licensee and an assistant. LPA observed 9 preschool age children with two staff members. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

LPA received copy of unusual incident report and the LIC 855 declaration dated 09/23/23 from the licensee and two assistants. The declarations stated that staff have never witness any inappropriate interaction or inappropriate touching between the children. Additionally, all three staff are always supervising the children very closely the whole duration the children are in daycare, from the moment they arrive, until the time they leave the facility. During nap time, licensee present in the same room with all the children the full duration of their nap times. Licensee stated that there no way any inappropriate touching could happened.

LPA Nguyen contacted parent of C1, parent of C1 stated all the inappropriate touching incident was a misunderstanding, and C1 is still attending the daycare.

Based on the interviews, declarations reviewed, and observation during today’s inspection, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the inspection.

Continued on Page LIC 809-C

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: VU, CHI	FACILITY NUMBER: 304312159
	VISIT DATE: 09/26/2023

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Page LIC 809-C

Exit interview was conducted with licensee, Chi Vu. Notice of Site Visit was posted during the visit. The licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC809 (FAS) - (06/04)

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