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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313112
Report Date: 06/09/2025
Date Signed: 06/09/2025 05:49:49 PM

Document Has Been Signed on 06/09/2025 05:49 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:VO, THU TRUNGFACILITY NUMBER:
304313112
ADMINISTRATOR/
DIRECTOR:		VO, THU TRUNGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(657) 237-5044
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/09/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:45 PM
MET WITH:Vo, Thu Trung (Licensee) TIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On 6/9/2025, Licensing Program Analyst (LPAs) Vivian Trinh, and (LPA) Kathy Trinh conducted an unannounced subsequent visit to the facility to deliver the findings for a complaint that was initiated on 04/24/2025. LPAs Vivian Trinh and LPA Kathy Trinh observed that Adult 1 (A1) Le, Thi Quynh Mai has not received caregiver background checks, criminal record and child abuse index clearances or exemptions. In addition, during interviews licensee admitted that she hired adult 1 (A1) who worked in the month of June 4, 2025 – June 9-2025. In addition, Adult 1 (A1) admitted that she begins working in this facility since June 4, 2025 until June 9, 2025. A1 was asked to leave immediately at 2:00pm. Licensee and A1 submitted the declaration form.

A review of the Facility Personnel Report Summary on this date 6/9/2025 indicated that A1 Le, Quynh Mai did not receive criminal record clearance prior to be in the facility and working with the children. Licensee admitted that the one adult (A1) did not receive criminal record clearance and licensee failed to report to the department of the new employee.

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. Currently there is 1 adult (A1 uncleared) including the licensee residing in the facility. Facility Day care hours are 7am-7pm, Monday through Friday.

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NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: VO, THU TRUNG
FACILITY NUMBER: 304313112
VISIT DATE: 06/09/2025
NARRATIVE
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Based on observation interview and record review the following violations were observed, accordance with California Code Regulations, Title 22, Division 12, Section 102370(d)(1) Criminal Record Clearance. Reporting Requirements, are being cited on the attached LIC 809D.

Due to the Type A violation cited today 6/9/2025 the licensee shall post and provide copies of the report to the parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of the children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledge Receipt (LIC 9224) signed by parents in each child's file. In addition, the licensee shall immediately post upon receipt the proof of correction for 30 consecutive days.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Thu Vo in Vietnamese.


End of the Report.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/09/2025 05:49 PM - It Cannot Be Edited


Created By: Vivian Trinh On 06/09/2025 at 03:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: VO, THU TRUNG
FACILITY NUMBER: 304313112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/09/2025
Section Cited
HSC
102370(d)(1)

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102370 ...(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement is not met as evidenced by:
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During inspection LPAs observed the one uncleared adult, who has not been fingerprint cleared. Licensee states they will ask A1 to completed the fingerprint and background check and until they receive crimial record clearance and submit to LPA.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. During interview with licensee, and A1 at 1:30 PM, licensee stated her new employee Le, Quynh Mai, has not been fingerprinted cleared, who worked in the month of June 4, 2025- June 9, 2025, which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2025


LIC809 (FAS) - (06/04)
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