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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411028
Report Date: 03/30/2023
Date Signed: 04/04/2023 10:24:24 AM

Document Has Been Signed on 04/04/2023 10:24 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:NGUYEN, TRINHFACILITY NUMBER:
434411028
ADMINISTRATOR:NGUYEN, TRINHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 677-4308
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 4DATE:
03/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH:Trinh NguyenTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Trinh Nguyen, and explained the nature of today’s inspection. LPA observed 2 adults (Licensee and Assistant- Tri La) and 4 children( 1 infant, 3 preschool) in the home during today’s inspection. Licensee was operating within the ratio and capacity requirements of her license. Days and hours of operation are Monday to Friday 7:30 am to 5:30 pm. LPA observed all required posted materials near the front entrance to the home. Trinh Nguyen and husband- Cheyrithy Bon are the adults that reside in the home. Licensee has 3 minor children, ages 16, 15 and 8 residing in the home. Licensee informed LPA of two children with Hand, Foot and Mouth Disease in the past two weeks. LPA advised licensee to submit an incident report and contact the Department of Public Health. Licensee submitted an LIC 624 during facility Inspection.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-677-4308). LPA observed age-appropriate materials, toys, and play equipment in the facility. Furniture, such as tables, chairs, cots and shelves, are in good condition. The floors were free of tripping hazards with toys put away in bins/baskets. The home has central heating/cooling and ventilation for comfort of children. The home is single story. Off limit areas inside the home: living room, bedrooms, office and attached garage. There are no stairs inside the home. Off limit areas outside the home: right side storage section & two canopy areas in the back section of the backyard. Backyard is fenced. Children are dropped off through the gate on the left side section of the home. There are no bodies of water. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable.

LPA observed a fully charged 2A10BC fire extinguisher in the play area and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. All cleaning compounds and other similar items are stored inaccessible to children.

Drinking water is readily available for children in the home via individual water bottles. Licensee states that she provides meals and snacks to the children in care.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: NGUYEN, TRINH
FACILITY NUMBER: 434411028
VISIT DATE: 03/30/2023
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LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was documented on 11/04/2022. LPA obtained copy of children's roster. Four (4) children’s files were reviewed during today's inspection and found to be current and up to date. Licensee states that she does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). LPA discussed the safe sleep regulations with Licensee, including documentation that shall be maintained and conducting 15-minute checks on all sleeping infants. LPA discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA provided licensee with a copy of an Individual Infant Sleeping Plan (LIC 9227) and a sample 15- minute sleeping infant check form.

LPA reviewed two staff files (Licensee and one adult assistant) and the files were complete with the required forms. Licensee and staff have current Pediatric CPR/First Aid certification with an expiration date of 06/2024. Licensee has the required vaccines (MMR, Tdap, & flu - opt out) and is current with Mandated Reporter Training for Child Care Workers. Licensee and staff Mandated Reporter Training expires on 08/2024. Assistant (Tri La) does not have record of Tdap vaccination on file. All individuals have clearances for Tuberculosis, Criminal Background, and Child Abuse Index Checks.

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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov/ www.ccld.ca.gov to access resources for providers, regulations, adoptions of new laws, pay annual fees etc.

Licensee states that a child will be isolated in the play room book area if necessary due to illness or communicable disease. Licensee conducts temperature checks upon childrens' entry and COVID tests every Tuesday and Thursday. Licensee states that she does not administer any medications to the day care children at this time.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
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 JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: NGUYEN, TRINH
FACILITY NUMBER: 434411028
VISIT DATE: 03/30/2023
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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 Americans with Disabilities Act (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.

Licensees stated that they sometimes transport children. LPA reminded Licensee that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.



To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to inspectionprocess@dess.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/process.

As a result of today's inspection, there were no deficiencies cited.


A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
LIC809 (FAS) - (06/04)
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