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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415162
Report Date: 03/06/2025
Date Signed: 03/06/2025 04:09:10 PM

Document Has Been Signed on 03/06/2025 04:09 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: 13DATE:
03/06/2025
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:01 PM
MET WITH:Nguyen NguyenTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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At 3:01 p.m., Licensing Program Analyst (LPA) Syeda Bahar and Licensing Program Manager (LPM) Belinda Devall, met with Licensee Nguyen (Kevin) Nguyen to conduct an unannounced annual/required inspection. Present for this inspection was two adult assistants, one infant, one school age child and eleven preschoolers.

The home was toured to conduct a Health and Safety Inspection. Days and hours of operation are from 8:00 a.m. to 6:00 p.m., Monday to Friday.

Children's files were reviewed for census. At this time, the annual required will be continued.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. A copy of the appeal rights were given to Nguyen (Kevin) Nguyen.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Syeda Bahar
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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