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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416261
Report Date: 03/08/2024
Date Signed: 03/10/2024 11:02:41 AM

Document Has Been Signed on 03/10/2024 11:02 AM - 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:NGUYEN, VANFACILITY NUMBER:
434416261
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 4DATE:
03/08/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Van NguyenTIME COMPLETED:
04:00 PM
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On 03/08/2024 at 1:55pm, Licensing Program Analyst (LPA) Farida Raja conducted an unannounced Case Management- Licensee Initiated inspection. LPA met with assistant, Thi Thu Trang Pham and explained the reason for the inspection. The purpose of this inspection is Licensee is requesting a change of capacity to a large family child care home and addition of co-licensees, Thi Thu Trang Pham and Thi Anh Huynh. Licensee, Van Nguyen arrived at 2:25pm. Licensee has been licensed since 08/27/2020. A fire clearance for 14 children was granted on 02/08/2024. Present during today's inspection were assistant and four preschool children.

LPA toured the inside and outside of the home. The off-limit areas of the home are the entire second level and attached garage. LPA observed barricaded stairs to the second level during today's visit. On limit areas include the living room, bathroom, family room, kitchen, dining area and play room. Licensee stated that children will only use the play room and sick children will be isolated in the living room if necessary due to illness or communicable disease. Kitchen may be used only for hand washing. There are sufficient toys for the children in care. All disinfectant, cleaning supplies, and other items that are dangerous to children were inaccessible to children. Napping mats are appropriate. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector and fire pull station. Licensee stated that there are no pets or weapons including firearms in the home. LPA observed a fish tank in the family room that did not have any fish.

Backyard was observed to be fenced. The entrance to the daycare is through the left side gate. The left side gate leads to the sliding door of the play room. The off-limit areas outside include the barricaded right side area. LPA observed a storage room and advised Licensee to place a child lock so children cannot access it. There were no bodies of water observed.

Adults 18 and over living in the home are Licensee and co-sisters, Thi Thu Trang Pham, Thi Anh Huynh, Thi Kim Thoa Vo, Thi Kim Thoa Nguyen, Thi Ngoc Duong Vo and Tuyet Hong Tran. All adults have cleared criminal record, child abuse, and Tuberculosis test. Co-licensees Thi Thu Trang Pham and Thi Anh Huynh have completed Family Child Care Home Orientation, Preventive Health, Safety, Nutrition and Lead Poisoning training, current Pediatric CPR and First Aid certification and obtained immunization's for measles, pertussis and influenza.



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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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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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: NGUYEN, VAN
FACILITY NUMBER: 434416261
VISIT DATE: 03/08/2024
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Co-licensee's are not fluent in English and are exempt from completing the Mandated Reporter Training for childcare providers at this time. Licensee provided proof of residence of co-licensees at this address.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA reminded licensee to obtain a copy of an Individual Infant Sleeping Plan (LIC 9227) for infants 12 months and under and conduct and log 15- minute sleeping infant check for children under 2 years of age.

LPA discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home shall be either 12 children, no more than four of whom may be infants; or more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for. When Licensee have more than 12 and up to 14 children in the home, Licensee must notify the parent using the form LIC 9150 (Parent Notification Additional Children in Care).

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/.

As a result of today's inspection, there were no deficiencies cited. Licensee was informed that a Large Family Child Care Home License will be granted completion of the following and manager approval.
1. Proof of covered air conditioning condensers and fans.
2. Lock on outdoor storage area to prevent access to children.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC809 (FAS) - (06/04)
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