434415162-1-14-2026-07-CC-JBER-DQBS22-20260114122848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415162
Report Date: 01/14/2026
Date Signed: 01/14/2026 12:29:12 PM

Document Has Been Signed on 01/14/2026 12:29 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, NGUYEN		FACILITY NUMBER:	434415162
ADMINISTRATOR/ DIRECTOR:	NGUYEN NGUYEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 564-3617
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	01/14/2026
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:25 AM
MET WITH:	Nguyen (Kevin) Nguyen - Licensee		TIME VISIT/ INSPECTION COMPLETED:	12:45 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	Licensing Program Analyst (LPA), Jennifer “Jen” Beehler, met with Licensee, Nguyen Nguyen (Kevin) for an unannounced Annual/Required Inspection. LPA was granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. Upon arrival, there were 8 children (6 - preschool-age / 2 - infant-age) and 2 staff (licensee/assistant) present, which is compliant with the home license capacity and ratio requirements. LPA observed all required postings near the entrance to the home. Hours of operation for the facility are Monday – Friday, 08:00AM-06:00PM. There are no active waivers. Licensee states that he is the only adult living in the home. His 15 year old daughter also lives in the home and was present at the beginning of the inspection. Licensee, Nguyen Nguyen (Kevin) was reminded that all adults 18 and over living or working in the home, 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. All adults present have criminal record clearance and are associated on the Guardian Roster for the facility. LPA reviewed facility roster (LIC9040) and fire/disaster drill log during todays inspection. The last fire/disaster drill was last conducted on 06/10/2025. Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

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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Document Has Been Signed on 01/14/2026 12:29 PM - It Cannot Be Edited

Created By: Jennifer Beehler On 01/14/2026 at 10:49 AM

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, NGUYEN	FACILITY NUMBER: 434415162
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations, the licensee did not comply with the section cited above. Fire extinguisher was manufactured in 2021 and had not been serviced since purchase, this poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2026
	Plan of Correction
1 2 3 4	Replace or service fire extinguisher Annually in accordance with State Fire Marshall Regulations.

Type B

Section Cited

CCR

102425(b)(3)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. (3) There shall be no objects hanging above or attached to the side of the crib. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations, the licensee did not comply with the section cited above in 3 out of 3 cribs had foam attached with zip ties, towels draping over the crib or items stored inside a crib used for infant sleep. Children were not sleeping in the cribs at the time of observation. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2026
	Plan of Correction
1 2 3 4	Remove all items attached to the crib. Determine alternative location to store blankets, stuff animals and sheets to ensure the crib is not contaminated by the sharing of other children in care's possessions, blankets or toys.

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

	Deanna Villagrana
NAME OF LICENSING PROGRAM MANAGER:

	Jennifer Beehler
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/14/2026 12:29 PM - It Cannot Be Edited

Created By: Jennifer Beehler On 01/14/2026 at 10:49 AM

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, NGUYEN	FACILITY NUMBER: 434415162
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 7 out of 13 files were missing immunization records or the records had not been updated in over one year. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2026
	Plan of Correction
1 2 3 4	Licensee to collect missing immunization records, update all children's records as necessary and provide the Department with a written plan on how to manage immunizations so that all children in care have up to date records.

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.

	Deanna Villagrana
NAME OF LICENSING PROGRAM MANAGER:

	Jennifer Beehler
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN, NGUYEN	FACILITY NUMBER: 434415162
	VISIT DATE: 01/14/2026

NARRATIVE

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During today's inspection, Licensee and assistant conducted a fire drill. LPA observed the children and staff exit through the front of the house and walk to the sidewalk to complete this requirement. LPA observed a 2A10BC fire extinguisher Manufactured in 2021 and it did not have a service certificate present which is not compliant with State Fire Marshall Regulations. LPA observed a fully functioning smoke detector and carbon monoxide detector. Licensee states that he does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas of the home (indoors): four (4) bedrooms, home office, two (2) bathrooms and the closet. There are no open-faced heaters or fireplaces present in the home. LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. Drinking water is readily available for children in the facility via water faucet at the sink with a filter. Children bring reusable bottles from home and are labeled with their names. The bathroom used for the facility is clean, sanitary, and operable. The Licensee has a working telephone in the facility. Licensee states there are no weapons or firearms on the premises.

The backyard area of the home was inspected. LPA observed sufficient play equipment and supplies for the children that are in good condition and age-appropriate. There were deep crevices under the green turf that were a tripping hazard for children. A climbing structure made of fabric was present in the backyard and is not age appropriate for preschool and infant age children. Off limits areas outside are: the front yard, side yards and a majority of the back yard that is fenced off from the children's play yard.

Continued on Page 3

NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN, NGUYEN	FACILITY NUMBER: 434415162
	VISIT DATE: 01/14/2026

NARRATIVE

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LPA observed the licensee and helper engaged with the children. Singing songs and playing games, and providing a hot lunch. Children were affectionate with the licensee and appeared to be having fun with the other day care children.

Infant Safe Sleep regulations (PIN 20-24-CCP) were discussed with the Licensee, including the Individual Infant Sleeping Plan (LIC9227). LPA reminded Licensee that infants up to 12 months of age should be placed on their back to sleep, that cribs should be free of all loose articles and hanging objects, and that infants should not be swaddled. Infants should be supervised while sleeping and documentation of sleep checks every 15 minutes should remain in the infant’s file. Documentation should include the time of the check, the infant’s physical condition, and initials of the staff member checking on the infant.

LPA discussed the safe sleep regulations with licensee, Nguyen Nguyen (Kevin) 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 licensee Nguyen Nguyen (Kevin) 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.

13 children’s files (10 - Preschool Age, 3 Infant Age) were reviewed during todays inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Acknowledgment of Receipt of Licensing Report (LIC9224) dated 07/24/2025, Affidavit Regarding Liability Insurance (LIC282), Immunization Records (PM286), for infants in care Individual Infant Sleep Plan (LIC9227) and sleep check documentation were also reviewed. LPA observed files missing immunization records and some documentation was incomplete. LPA observed all infant sleep check documentation to be complete for infants enrolled. LPA reviewed missing and incomplete documents with licensee to ensure understanding for future compliance.

Continued on Page 4

NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NGUYEN, NGUYEN	FACILITY NUMBER: 434415162
	VISIT DATE: 01/14/2026

NARRATIVE

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Three (3) staff files (1- Licensee/ 2 - Assistants) were reviewed for the following records: Employee Rights (LIC9052), Statement Acknowledging Requirement to report Child Abuse (LIC9108), Mandated Reporter Training Certificate, and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza or statement declining influenza. There is at least one staff member present with current CPR/First-Aid that expires 06/2027. The Licensee has current Mandated Reporter Training that expires on 10/22/2026. Licensee's CPR/First Aid was expired, LPA reminded licensee that all training must be renewed every two years and that a staff person with valid CPR/First Aid must be present at all times.

Supervision of children was discussed with the Licensee and he understands that he must be home during day care hours and ensure that children are supervised at all times. The Licensee states that he does not transport any day care children. LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

During the exit interview, the Licensee, Nguyen Nguyen (Kevin) confirmed that there are no Registered Sex Offenders (RSO) living in the facility and LPA completed the Megan's law search online to verify there are no RSO's at the facility address and created the RSO profile in FAS.

As a result of todays inspection, One Technical Violation and Three (3) Type B Citations are cited. More details provided on the attached LIC809-D pages. Exit interview conducted with Licensee, Nguyen Nguyen (Kevin). Report was reviewed and provided along with appeal rights.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.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/inspection-process.

NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC809 (FAS) - (06/04)

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