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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413894
Report Date: 03/01/2023
Date Signed: 03/23/2023 10:17:18 AM

Document Has Been Signed on 03/23/2023 10:17 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,NGHIA HIEUFACILITY NUMBER:
434413894
ADMINISTRATOR:NGUYEN,NGHIA HIEUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 401-9729
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
03/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:NGHIA HIEU NGUYENTIME COMPLETED:
04:35 PM
NARRATIVE
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*This report is amended to correct Licensee's Mandated Reporter Training expiration date from February 1, 2022 to February 1, 2024*
Licensing Program Analysts (LPAs), Farida Raja and Joe Macias, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Nghia Nguyen and explained the nature of today’s inspection. LPA observed 2 adults- Licensee and assistant (Xuan Hoa Nguyen) and 12 children( 4 infants, 8 preschool aged) 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 8:00 am to 5:00 pm. LPA observed all required posted materials, including facility license, emergency disaster plan and parents rights form near the front entrance to the home. The adults that reside in the home are Licensee, husband, licensee's mother and father and roommate (Hoaian Nguyen). Licensee has 2 minor children, ages 4 and 11 residing in the home.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home. (408-401-9729, Spouse- 408-420-2847). LPA inspected home for any health and safety hazards. LPA observed age-appropriate materials, toys, and play equipment in the facility. LPAs observed a baby walker in the home and asked licensee to remove it. Furniture, such as tables, chairs, cribs, feeding chairs 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. A thermostat was observed. The home is two story and LPA observed barricaded stairs during today's inspection. Off limit areas inside the home: entire upstairs, downstairs(kitchen) and attached garage. Off limit areas outside the home: back section of the backyard. Backyard is fenced and both sides of the home are gated. There are no bodies of water.

LPA observed a fully charged 3A40BC fire extinguisher in the downstairs bedroom hallway and working smoke/carbon monoxide detector. The Licensee states that she does not have any weapons or pets in the home. LPAs observed chemicals- Raid Ant Killer and Windex Glass Cleaner in the diaper changing area within children's reach which Licensee moved to higher cabinets while LPAs were present. Licensee has a first aid kit in the master bedroom of the home. Licensee understands that smoking is prohibited in the home.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 03/23/2023 10:18 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/03/2023 02:43 PM


Created By: Farida Raja On 03/01/2023 at 02:57 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN,NGHIA HIEU
FACILITY NUMBER: 434413894

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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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While conducting a facility tour LPAs observed chemicals- Raid Ant Killer and Windex Glass Cleaner near the diaper changing area and within children's reach which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2023
Plan of Correction
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Licensee removed these chemicals, while LPAs were present, from near the diaper changing area and placed them in a higher cabinet away from children's reach. The Licensee will submit a letter of understanding, outlining how this will be avoided in the future. LIC9224 must be signed by all parents currently enrolled and must be provided to all future enrollments for the next 12 months and maintained in file.
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/01/2023 04:21 PM - It Cannot Be Edited


Created By: Farida Raja On 03/01/2023 at 02:57 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN,NGHIA HIEU
FACILITY NUMBER: 434413894

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Licensee did not conduct and document 15 minute checks on sleeping infants and maintain documentation in file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/03/2023
Plan of Correction
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The Licensee will submit proof to CCL by the POC date.
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2023


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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,NGHIA HIEU
FACILITY NUMBER: 434413894
VISIT DATE: 03/01/2023
NARRATIVE
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Drinking water is readily available for children in the home via individual water bottles. Licensee provides breakfast, lunch and snacks for children in care. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored.

LPA reviewed a current Child Care Facility Roster (dated 03/01/2023) and Fire/Disaster drill log during today's inspection. Fire/disaster drill was conducted on December 9, 2022. LPA obtained copy of children's roster. Children file review was completed and found to be current and up to date. Ten (10) children’s files were reviewed during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records (PM 286/CDPH 286). 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 reviewed two infant children's files and the files were complete with the required forms, including the Individual Infant Sleeping Plan (LIC 9227). Licensee did not conduct 15- minute checks on napping infants.

LPA reviewed two staff files (Licensee and one adult assistant) and the files were complete with the required forms. Licensee has current CPR and First Aid certifications (expiration: 04/2023). Licensee and staff have the required vaccines (MMR, TDAP and Influenza Vaccine). Licensee is current with Mandated Reporter Training which expires on February 1, 2024. Assistant (Xuan Nguyen) is exempt from completing the training as she does not speak English. LPA informed licensee that all the adults in contact with children in her home are required to complete the training. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years, website: www.mandatedreporterca.com.

Supervision of children was discussed with Licensee and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

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

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
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,NGHIA HIEU
FACILITY NUMBER: 434413894
VISIT DATE: 03/01/2023
NARRATIVE
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LPA reviewed with licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500 ("zero tolerance"). Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.

LPA discussed the safe sleep regulations with Licensee and 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. Licensee does not document 15- minute checks on sleeping infants. LPA provided licensee information on Safe Sleep Regulations and conducting and documenting 15-minute checks.

Licensee states that a child will be isolated in the living room snack table due to illness or communicable disease. Licensee states that she does not administer any medications to the day care children at this time. 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.

LPA also informed Licensee 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.



Licensees stated that they 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.

Exit interview conducted and report was reviewed with the Licensee, Nghia Nguyen.

As a result of today's inspection, there was one TYPE A and two TYPE B deficiencies were cited.

Child Care Parent Notification Requirements and Acknowledgement of Receipt of Licensing Reports (LIC9224) was also explained and provided to Licensee during today’s Inspection.

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: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 03/01/2023 04:21 PM - It Cannot Be Edited


Created By: Farida Raja On 03/01/2023 at 03:22 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN,NGHIA HIEU
FACILITY NUMBER: 434413894

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(A)(10)(b)
A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846 (b) and (c)

This requirement is not met as evidenced by:
Deficient Practice Statement
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While conducting a facility inspection, LPAs observed a baby walker in the family child care home which poses a potential health, safety or personal rights risk to persons in care. LPAs asked licensee to remove it immediately.
POC Due Date: 03/01/2023
Plan of Correction
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Licensee will submit a letter of understanding that states that banned items will not be stored or kept in the areas accessed by children at any time.
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2023


LIC809 (FAS) - (06/04)
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