414005252-10-15-2025-05-CC-MOLN-DMGVBB-20251015161717

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005252
Report Date: 10/15/2025
Date Signed: 10/15/2025 04:17:43 PM

Document Has Been Signed on 10/15/2025 04:17 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	TRAN, ANDY		FACILITY NUMBER:	414005252
ADMINISTRATOR/ DIRECTOR:	TRAN, ANDY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 281-1556
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94062
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	10/15/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:01 AM
MET WITH:	Andy Tran		TIME VISIT/ INSPECTION COMPLETED:	04:35 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 October 15, 2025, at approximately 9:10am Licensing Program Analysts (LPAs) Maria Olguin-Leon and Melissa Zaragoza met with applicant, Andy Tran to conduct a scheduled prelicensing relocation visit. LPAs explained the purpose of the inspection to applicant. Applicant submitted a relocation application to Regional Office on June 13, 2025. Applicant is currently licensed in main home, license #414003086 and has requested to relocate to ADU on same property with different address, which is currently licensed under #414005187. Present in ADU during today’s visit was applicant and two assistants caring for 10 children (3 infants & 7 preschool age). Type A deficiency was issued today for unlicensed care, as ADU is currently licensed under another licensee. Per applicant, applicant lives in ADU, based on inspection, there is doubt applicant is residing in ADU. All adults present have a criminal background clearance. Applicant plans to provide care for children 18 mths – 8 yrs. old. Hours of operation Monday-Friday 8:00am – 5:30pm. LPAs inspected the indoors and outdoors of ADU for health and safety hazards. Applicant owns property where main home and ADU are located and listed under two separate addresses. LPAs observed ADU is one large room with a bathroom, the entire ADU will be used for daycare areas. LPA observed a childproof gate installed in hallway of entrance into ADU. The bathroom is equipped with a shower, sink, toilet and a cabinet with paint art supplies. LPAs observed a cabinet next to bathroom with a changing mat on top of cabinet with children’s diapering supplies. LPA’s reminded applicant to clean and disinfect diapering area after each use. ADU is equipped with a refrigerator, stove, sink and microwave. LPAs observed ADU has a separate front door entrance and side door of ADU leading into shared backyard. LPAs observed ADU to be clean and organized with proper lighting and ventilation. All electrical outlets are secured with childproof covers. ADU was equipped with cubbies for children to store their own personal belongings. Child size furniture, learning materials, age-appropriate toys and sleeping cots were observed in good condition. Parents will provide bedding for sleeping cots and will be sent home weekly for laundering. LPA’s observed rugs in ADU to cushion and absorb falls. Per applicant, sleeping cots are cleaned and disinfected daily. All detergents, cleaning compounds, medications and other items which could pose a danger are stored inaccessible to children behind child safety locked cabinets. Per applicant, there are no weapons or firearms in the home. Cont. page 2...

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TRAN, ANDY	FACILITY NUMBER: 414005252
	VISIT DATE: 10/15/2025

NARRATIVE

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Backyard is accessible through side door of ADU. The entire backyard is enclosed with a 5 ft wood fence and gate, main home and 2 ft wired fence. Backyard has a climbing/slide structure, climbing dome, ride on toys, playhouses, child size furniture, all in good condition. Patio deck provides shade to children in care and has child swings attached. Backyard flooring is cement and play structure flooring is sand to absorb and cushion falls. LPAs did not observe any spas, pools, or bodies of water

Home is equipped with a dual working carbon monoxide/smoke detector. LPA observed a fully charged fire extinguisher (2-A:10 B:C) in entrance hallway, which is easily accessible. LPA observed a first aid kit fully stocked with necessary supplies. Applicant uses a designated cell phone and is aware the cell phone must stay within the home during the day care hours. The isolation area for sick children will be in the outdoor patio with an assistant and away from other children. Applicants discipline policy will be redirection.

LPAs reviewed the LIC311D, Records to Keep in Your Family Childcare Home, children’s forms/ records, facility forms, and information to be posted. Entrance Checklist was provided to the applicant. Applicant’s CPR/First Aid certification expires 1/2027 and Mandated reporter expires 06/2026.

LPAs and applicant discussed licensing regulations and the capacity requirements. Any children under 10 years of age that live in the home will be counted in overall capacity. LPAs reminded applicant they must be present at home 80% of operating hours. Applicant plans to provide meals for children in care, which will include a morning snack, lunch and dinner. LPAs discussed sanitation and allergies with applicants. LPAs reminded Applicant to label all food brought from home.

Applicant understands the required emergency disaster drills are to be conducted and documented at least once every six months. Applicant understands that the use of baby walkers, bouncers, jumpers, and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Cont. page 3...

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TRAN, ANDY	FACILITY NUMBER: 414005252
	VISIT DATE: 10/15/2025

NARRATIVE

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The applicant provided proof of control of property.

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) or (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.

LPAs discussed the safe sleep regulations with applicant 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 applicant 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.

On this date, 06/16/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TRAN, ANDY	FACILITY NUMBER: 414005252
	VISIT DATE: 10/15/2025

NARRATIVE

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Applicant was informed of the MyChildCarePlan.org site, 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 meeting conducted on 03/20/2025, applicant was reminded:

Applicant is the main provider for the licensed ADU.
Applicant’s substitute cannot be another licensed provider.
If Applicant (or substitute) is working alone in licensee's ADU home, licensee (or substitute) must operate within capacity limits of a small, licensed family childcare home.
Applicant will have their own designated staff; no sharing of staff will be allowed with staff working in ADU. only in case of emergency.
Applicant understands there will be separate entrances for daycares. Applicants’ daycare entrance will be the main entrance into ADU.
Applicant cannot engage in outside employment that may directly or indirectly infringe applicant's ability to be the primary caregiver in their family childcare home(ADU)
Applicant is the only individual responsible and liable for everything that occurs in the ADU.
Applicant understands children enrolled with licensee shall not commingle with children enrolled in main home.
Applicant understands there shall be a rotation schedule between both daycares for outdoor shared space. Rotation schedule shall be submitted to the licensing office.
Applicant understands all enrolled children files must be kept in the ADU and not kept in the main home. Applicant understand all adults living or working in the ADU must be fingerprint cleared and associated to ADU
Applicant must live in the ADU.
Applicant must be present 80% of operating hours, per day.
Applicant must be aware of the department’s regulations.
Applicant must have their own current working phone number the department can reach during operating hours.

Applicant stated they understood and are aware of the importance to be in compliance with all licensing regulations.

Cont. Page 5...

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TRAN, ANDY	FACILITY NUMBER: 414005252
	VISIT DATE: 10/15/2025

NARRATIVE

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LPA’s reminded applicant of the following:

Applicant must use their own facility number for advertising purposes.
Applicant understands ADU and Main home daycares cannot advertise as one facility and must advertise as separate facilities.

Applicant was also reminded about capacity limits and ratios for a large family day care home. LPAs reminded applicant that an assistant must be present when operating as a large license. LPAs reminded applicant when an assistant is not present, applicant must operate within capacity limits of a small family child care home.

During today’s inspection, LPAs issued a type A deficiency due to unlicensed care being provided in ADU by applicant. See LIC809D for additional information.

LPA’s Olguin-Leon and Zaragoza informed applicant, Andy Tran that this report dated October 15, 2025, document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Olguin-Leon and Zaragoza informed the applicant, Andy Tran, to provide a copy of this licensing report dated October 15, 2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements may result in an immediate civil penalty of $100. This report is public and can be reviewed.

Prior to recommendation for approval of relocation
- Pending management additional review and approval

Exit interview conducted and report was reviewed with the applicant, Andy Tran. Appeal rights were provided to applicant.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Maria Olguin-Leon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/15/2025 04:17 PM - It Cannot Be Edited

Created By: Maria Olguin-Leon On 10/15/2025 at 03:05 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TRAN, ANDY	FACILITY NUMBER: 414005252
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Deficiency Dismissed

Type A

Section Cited

CCR

102357(a)(2)

102357 Operation Without a License (a) If the Department has reason to believe that family child care is being provided without a license, the licensing agency shall: (2) Notify the unlicensed provider in writing of the requirements for such licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the applicant did not comply with the section cited above in applicant was observed providing care to children in ADU, which is unlicensed to the applicant., which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/16/2025
	Plan of Correction
1 2 3 4	Applicant will not provided care to chidlren in ADU, as applicant is currently licensed in the main home. Applicant will stop providing care to children in ADU and current licensee will be the only licensee providing care in ADU at this time.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:

	Maria Olguin-Leon
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

LIC809 (FAS) - (06/04)

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