434416193-11-4-2024-07-CC-FRAA-DAQ7R9-20241104205309

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416193
Report Date: 11/04/2024
Date Signed: 11/04/2024 08:53:18 PM

Document Has Been Signed on 11/04/2024 08:53 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	DOAN, HONG LOAN		FACILITY NUMBER:	434416193
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 7	DATE:	11/04/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:55 AM
MET WITH:	Hong Doan		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

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	On 11/04/2024 at 8:55am, Licensing Program Analysts (LPAs), Farida Raja and Syhshyan Yu, conducted an unannounced annual/random inspection. LPAs were granted access to the home by Licensee, Hong Doan and explained the nature of today’s inspection. As Licensee primarily speaks Vietnamese and very little English LPAs used the Language Interpreter Service during today's inspection. Upon arrival LPAs observed Licensee and four preschool children. Children continued to arrive during today's inspection. Licensee's assistant arrived a little later. Licensee was operating within ratio and capacity requirements of the license. Days and hours of operation are Monday to Friday, 7:00 am to 5:00 pm. LPAs observed all required posted materials near the front entrance to the home. As per Licensee, two adults reside in the home. There are no minor children residing in the home. LPAs toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home. LPAs observed some toys and play equipment for the day care children. The home has central heating/cooling and ventilation for comfort of children. The home is two story and LPAs observed barricaded stairs during today's inspection. On limit areas inside the home include: two bedrooms and one half bath on the lower level. Entire upstairs is off limits to the children. Off limit areas outside the home: entire right and left side sections. On limit area outdoors includes the artificial grass area in front of the home. Backyard is fenced. Both sides and front of the home are gated. Outdoor equipment was observed to be safe and age appropriate. There are no bodies of water observed. LPAs observed that the half bath used by children was in operating condition. Toilets and faucet are operable. Upon facility walk through LPAs observed a lot of cobwebs in the two on limit bedrooms and kitchen area of the home. LPAs advised Licensee that the home needs to be clean and in good repair for children in care. LPAs observed a fully charged 3A40BC fire extinguisher near the stairs going to the second level. LPAs observed a working smoke/carbon monoxide detector and fire pull alarm. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

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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Document Has Been Signed on 11/04/2024 08:53 PM - It Cannot Be Edited

Created By: Farida Raja On 11/04/2024 at 11:08 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: DOAN, HONG LOAN	FACILITY NUMBER: 434416193
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(b)

Operation of A Family Child Care Home

(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. During facility walk through LPAs observed a lot of cobwebs in the two on limit bedrooms and kitchen area of the home. LPAs advised Licensee that the home needs to be clean and in good repair for children in care.
	POC Due Date: 11/11/2024
	Plan of Correction
1 2 3 4	Licensee to submit a plan of correction to LPS by plan of correction date of 11/11/2024.

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.

SUPERVISOR'S NAME:

Gladys Kuizon

LICENSING EVALUATOR NAME:

Farida Raja

LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

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: DOAN, HONG LOAN	FACILITY NUMBER: 434416193
	VISIT DATE: 11/04/2024

NARRATIVE

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LPAs reminded licensee that the fire extinguisher needs to be serviced once every 12 months. Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, poisons, medications, sharp objects and other similar items were observed to be stored inaccessible to children. Licensee understands that smoking is prohibited in the home.

Drinking water is readily available for children in the home via individual water bottles. Licensee states that parents bring meals and snacks and licensee provides them occasionally as well. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Licensee stated that a child will be isolated in an off limit area away from other children in case of illness or communicable disease until parent pick up.

LPAs reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was last conducted on 06/24/2024. LPAs obtained copy of children's roster.

Children file review was completed and found to be current and up to date. Five (5) children’s files were reviewed during today's inspection. Licensee does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). Licensee does not provide care to infants.

LPAs reviewed two staff files (Licensee and assistant) for the required forms. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee and assistant have current Pediatric CPR/First Aid certification (expires 09/06/2025). Licensee and staff have the required immunization in file for measles, pertussis and influenza. LPAs reminded Licensee to maintain proof of influenza immunization's each year. Both licensee and staff are not fluent in English. Licensee and assistant are exempt from completing the Mandated Reporter Training at this time since it is not offered in their primary language of Vietnamese. Licensee understands the training is mandatory to all Licensees and adults in the home in contact will children and requires renewal every two years. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

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: DOAN, HONG LOAN	FACILITY NUMBER: 434416193
	VISIT DATE: 11/04/2024

NARRATIVE

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Licensee 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.

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. LPA discussed the requirement for Licensee to be present at the facility 80 percent of the hours the facility is in operation and that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. Licensee understands her capacity options and she understands that she cannot have more than 8 children in the home at any time and ratio (age of the children) must be observed.

LPAs discussed "zero tolerance" related regulations which includes the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Licensee is encouraged to visit the Department’s website at https://cdss.ca.gov/inforesources/child-care-licensing to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc. The Department will communicate all new information to providers through Provider Information Notices (PINs). Please sign up to be notified for new PINs at www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and visit the Department’s website for the latest PINs.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. Licensee states that she is not providing medications or IMS to children at this time. 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/.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

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: DOAN, HONG LOAN	FACILITY NUMBER: 434416193
	VISIT DATE: 11/04/2024

NARRATIVE

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Licensee states that she does not transport any day care children. LPAs reminded Licensee that if she decides to transport children, 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPAs conducted the staff interview that is part of the CARE tool using the Language Interpretation Service. One Type B deficiency was cited as a result of today's inspection. Appeal Rights provided.

Exit interview conducted and report was reviewed using Language Interpretation Service with the licensee, Hong Doan.

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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

LIC809 (FAS) - (06/04)

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