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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416203
Report Date: 09/24/2021
Date Signed: 09/24/2021 03:55:53 PM

Document Has Been Signed on 09/24/2021 03:55 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:HUYNH, JULIANFACILITY NUMBER:
434416203
ADMINISTRATOR:JULIAN HUYNHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 221-8818
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
09/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Julian HuynhTIME COMPLETED:
11:40 AM
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(#1)Licensing Program Analyst (LPA) Anna Morales conducted an ANNUAL REQUIRED visit. LPA was greeted Licensee Julian Huynh. Also present were three children. One child is under 12 months old, and two at 2 years old. LPA observed a current copy of Current Children Roster during visit. Days and hours of operation are Monday - Friday from 7:30 AM -5:30PM. Beside the Licensee residing at the house, the other adult over the age of 18 is the Licensee's boyfriend. All adults residing have Criminal Background Check Clearances, signed Criminal Record Statements LIC508 on file with Licensing Office.

LPA toured the indoor and outdoor areas of the home during today's inspection:

INDOOR/ OUTDOOR PACE: The day care areas for use include: the family room and activity room, one bathroom, the kitchen and a section of the backyard. All other areas / bedrooms in the home are off-limits which includes the garage, two bedrooms, and a portion of backyard. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Furniture and equipment, such as, mats, chairs, and tables were age appropriate and in good condition. There were no baby walkers or bouncers observed on the premise during today’s inspection. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters. LPA observed a fully charged 2A10BC fire extinguisher, functional smoke and carbon monoxide detectors, and first aid supplies in the home.
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SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HUYNH, JULIAN
FACILITY NUMBER: 434416203
VISIT DATE: 09/24/2021
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LPA reviewed a random selection of Emergency Information Cards (LIC700) and they were complete and updated.

LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who comes in contact with or provide care and supervision to the children. 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.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that they do not take care of children who are ill. 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. Licensees have an area where sick children can be isolated from the others until parent pick-up.

Licensee doesn't havea current Mandated Reporter Certificate. The last Mandated Reporter Certificate expired on 3/12/2020. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed atwww.mandatedreporterca.com.

Licensee does have acurrent CPR and Pediatric First Aid card. It expires on 9/12/2022.
Last Disaster Drill was conducted on 4/18/21.

Website for provider resources & licensing updates: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HUYNH, JULIAN
FACILITY NUMBER: 434416203
VISIT DATE: 09/24/2021
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LPA discussed the requirements of AB 633 with the Licensee and understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

LPA conducted an exit interview with the Licensee . LPA discussed and left a copy of Pin 20-24-CCP, RECENTLY APPROVED SAFE SLEEP REGULATIONS IN EFFECT. Discussed that all INFANTS UP TO 12 MONTHS OF AGE MUST HAVE AN INDIVIDUAL INFANT SLEEPING PLAN (LIC9227) ON FILE, WHICH WILL DOCUMENT THE INFANTS SLEEPING HABITS, USUAL SLEEPING ENVIRONMENT, AND THE INFANT ROLLING ABILITIES.

Deficiencies are being cited based on the LPA's observations, interviews conducted and records reviewed in accordance with the California Code of Regulations Title 22.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/24/2021 03:55 PM - It Cannot Be Edited


Created By: Anna Morales On 09/24/2021 at 10:48 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: HUYNH, JULIAN
FACILITY NUMBER: 434416203

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2021
Section Cited
HSC
1569.8662(4)(b)(1)

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MANDATED REPORTER TRAINING. [...] a person who, on January 1, 2018, is a licensed child care provider [...] shall complete the mandated reporter training provided [...] and shall complete renewal mandated reporter training every two years
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Licensee agreed to send copy of current training to CCL by the POC due date of 10/25/2021
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LPA observed that Licensee did have not current Mandated Reporter Training:It expired on 3/12/2020.This poses a potential risk to children's health and safety of children in care.
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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:Sandy Knight
LICENSING EVALUATOR NAME:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2021


LIC809 (FAS) - (06/04)
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