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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415162
Report Date: 11/26/2024
Date Signed: 11/26/2024 02:18:05 PM

Document Has Been Signed on 11/26/2024 02:18 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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:NGUYEN, NGUYENFACILITY NUMBER:
434415162
ADMINISTRATOR/
DIRECTOR:		NGUYEN NGUYENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 564-3617
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/26/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:38 PM
MET WITH:Nguyen NguyenTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
NARRATIVE
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Licensing Program Manager (LPM) Belinda Devall, Licensing Program Analysts (LPA) Andy Yang and Mel Matos met with Licensee Nguyen, Nguyen (Kevin) at the San Jose Child Care Regional Office. The purpose of this meeting was to discuss a recent violation of Title 22 regulations, that posed an immediate risk to the health, safety, and personal rights of children in care and concerns that occurred for the unannounced annual inspection.The following violation and concerns were discussed:

Type A Deficiency:

On November 19, 2024, the facility was cited for 102416.5(d)(2) – Staffing Ratio and Capacity.

Based on observation during the inspection, present at the facility were 14 children (1 infant and 13 preschool age). Licensee did not have any school age children present. A Large Family Child Care Home may provide care for more than 12 children and up to and including 14 children, if at least one child is enrolled in and attending kindergarten, including transitional kindergarten or elementary school and a second child is at least six years of age.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: NGUYEN, NGUYEN
FACILITY NUMBER: 434415162
VISIT DATE: 11/26/2024
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Concerns:

Discussion of Inspection Authority of the Department

On November 19, 2024, the assistants providing care and supervision for the children did not know the inspection authority of the Department when the LPAs presented their proper identification for the annual inspection. Per 102391(a), Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, the regulations adopted by the Department governing family child care homes, and in accordance with Section 102396.

Discussion of Operation of a Family Child Care Home

On November 19, 2024, the assistants disclosed to the LPAs that the licensee was not home and the LPAs had to call the licensee as they were in a different area of the home that was off limits and not providing care and supervision to the children. Per 102417(a), The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

The Licensee representative agreed to adhere to the staffing ratio and capacity for the home. Licensee was provided with the ratio chart providing during this meeting. The licensee agreed that they will ensure they are present and involved in the care and supervision of the children in care. The licensee will ensure there is an assistant present to provide care and supervision when the licensee is temporarily away from providing the primary care and supervision for the children. In addition, the licensee will ensure their assistants understands the authority of the Department and in their absence must be knowledgeable of the Title 22 regulations and remain in compliance at all times.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: NGUYEN, NGUYEN
FACILITY NUMBER: 434415162
VISIT DATE: 11/26/2024
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There were additional deficiencies that were potential risks observed during the inspection pertaining to a safety gate, staff personnel records, and children’s records that has been corrected.

LPM Devall explained to Kevin that if there are continued deficiencies cited for the issues noted on this report, the facility may be referred to the Department's legal department for possible administrative action, which could include revocation of the facility license. The facility will be monitored more frequently to ensure that the facility is in compliance with the Department regulations.

LPM Devall discussed the requirements of AB 633 with Kevin and provided him the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Kevin understands the requirements.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC809 (FAS) - (06/04)
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