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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625415
Report Date: 12/09/2024
Date Signed: 12/09/2024 01:16:17 PM

Document Has Been Signed on 12/09/2024 01:16 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:TA, XUAN & NGUYEN, NHUT FAMILY CHILD CAREFACILITY NUMBER:
376625415
ADMINISTRATOR/
DIRECTOR:		XUAN TA & NHUT NGUYENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 452-8521
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
12/09/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Xuan TaTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
NARRATIVE
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On 12/09/24 at 10:15 AM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with co-licensee, Xuan Ta. LPA disclosed the purpose of the inspection and was granted entry into the facility by the co-licensee. Co-licensee speaks very limited English but analyst was able to conduct the visit with assistance from the Language Link Translation Service. Three (3) children including the licensee's grandson were in the home today. However, the licensee's grandson is not part of the daty care as he is under the direct supervision at all times of his mother, the cleared and associated Christine Nguyen, who lives in the home. This facility is a one floor, five bedroom, two bathroom house. Licensee accompanied LPA inside of the facility during this inspection.

The following areas used for child care are: the living room, the family room and the day care bathroom. Off limits areas are the kitchen five home bedrooms, the second bathroom and the garage. The kitchen was formerly a for use area but now has been made off limits with installed safety gated at both entrances. The day care bathroom is off the kitchen, however, licensee states she escorts children to the restroom when needed. The first two bedrooms and the second bathroom are in a separate portion of the home and are made off limits with an entry door with a door knob cover on it. The remaining three bedrooms are made off limits with a combination of locking door knobs or door knob covers that are installed on their respective door handles. The garage is made of limits with an entry way door that leads into it that has a highly placed dead bolt lock on it.

The fire extinguisher and combination smoke and carbon monoxide detector met requirements. Most hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced backyard but only a patio portion that is gated off is available for children for outdoor activities. The remainder of the yard will be off limits and will not be able to be accessed by the children due to the installed gating which has a lock on it.

No bodies of water observed on the premises during the inspection. Co-licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE
FACILITY NUMBER: 376625415
VISIT DATE: 12/09/2024
NARRATIVE
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Licensees' First Aid and CPR certifications expire on 07/20/26. Licensee has required immunizations. Co-licensee is currently exempt from Mandated Reporter Training. Facility roster is not maintained to reflect current census. The last fire and disaster drills were conducted and documented in November of 2017. Licensee currently has no infants in care but analyst provided her with a copy of the safe sleep regulations for her to review at a future date.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov

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.

Five type B violations California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

An exit interview was conducted with the co-licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/09/2024 01:16 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 12/09/2024 at 12:14 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE
FACILITY NUMBER: 376625415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst observation, the licensee did not comply with the section cited above as the cabinet below the bathroom sink had a broken latch on one of its door which made chemical cleansers like dishwashing detergent and others accessble to children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/11/2024
Plan of Correction
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Licensee removed all the chemicals underneath the bathroom cabinet and placed the in an area that is inaccessible to day care children. Licensee states she will install a new latch and send analyst a photo by 12/11/24 showing that it is done so that the correction can be considered completed. Deficiency was cited as a type B violation as the chemicals were all closed and licensee escorts all younger children to the bathroom.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 12/09/2024 01:16 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 12/09/2024 at 12:14 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE
FACILITY NUMBER: 376625415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst interview and record review, the licensee did not comply with the section cited above as, though she stated to analyst that she has been conducting fire and earthquake drills every six month as required, she has not been documenting them which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2024
Plan of Correction
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Analyst provided licensee with a blank copy of a fire drill log and licensee states that she will complete it by documenting the most recent fire and earthquake drills she has conducted within the past few attempts and send analyst a copy of that completed log by 12/16/24 to complete the correction.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2024


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 12/09/2024 01:16 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 12/09/2024 at 12:14 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE
FACILITY NUMBER: 376625415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst record review, the licensee did not comply with the section cited above as child #1 did not have copies of her required immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2024
Plan of Correction
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The deficiency was corrected during today's visit when the licensee contacted the child's parent and she texted her a copy off the missing shot records. Licensee will update the immunization records to blue shot cards and continue to update children's shot records as required. Licensee will also review her other files of part time children to ensure their immunization records are there and updated as required.
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst record review, the licensee did not comply with the section cited above none of her children's files had a signed copy of the Notification of Parent's Rights packet listed above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2024
Plan of Correction
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Analyst provided licensee with a blank copy of the Parent's Rights Packet to make copies of and provide to the parents to complete. Licensee will then send analyst a completed, signed copy of the receipt showing the parents received a copy and signed for it for the two children in care today by 12/16/24 to complete the correction.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 12/09/2024 01:16 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 12/09/2024 at 12:14 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE
FACILITY NUMBER: 376625415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst record review, the licensee did not comply with the section cited above as she did not have a facility roster on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2024
Plan of Correction
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Licensee was given a blank copy of a faciltiy roster and stated she will have her son assist her in completing it and then send a copy of it to analyst for review by 12/16/24 to complete the correction.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2024


LIC809 (FAS) - (06/04)
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