434416469-3-30-2021-07-CC-DMAC-BZLLBV-20210330083719

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416469
Report Date: 03/16/2021
Date Signed: 03/30/2021 08:37:25 AM

Document Has Been Signed on 03/30/2021 08:37 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	NGUYEN, MAGDALENE		FACILITY NUMBER:	434416469
ADMINISTRATOR:	MAGDALENE NGUYEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 238-9351
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/16/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Nguyen, Magdalene		TIME COMPLETED:	12:20 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) Dung Mac conducted an announced pre-licensing tele-inspection via video conference call (FaceTime) with Magdalene Nguyen, the Applicant. Applicant is currently licensed at 1874 Dandini Circle, San Jose, CA 95128 (Facility #: 434409648) and is applying for a change of location. A fire safety inspection request approval was received from the San Jose Fire Department on March 10, 2021. Days and hours of daycare are Monday to Friday from 8:00AM to 5:00PM. The adults that reside in the home: Applicant and two adult residents (Theresa Nguyen and MinhPhung Do). All individuals have clearances for Tuberculosis, Criminal Background, and Child Abuse Index Checks. Applicant's certifications of First Aid & CPR are current and expire on November 2021 and Mandated Reporter Training expires on 11/05/2022. Applicant's copies of immunization records are on file. Applicant rents the home and the Owner/Landlord Notification (LIC 9151) and Owner/Landlord Consent (LIC 9149) forms are on file. Applicant states that she does not have liability insurance and understands that if liability insurance is not carried, she will have the parents complete the Affidavit Regarding Liability Insurance (LIC 9182). Applicant states that she is not transporting children. Applicant agreed to give LPA a tour of the home (indoor/outdoor) via FaceTime during today's tele-inspection. The off-limit areas inside the home: bedroom #1, bedroom #2, bedroom #3, master bedroom, chapel, laundry room, and garage. Facility has a designated area where a child(ren) can be isolated if exhibiting signs of illness. Applicant states that she does not have firearms or pets in the home.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021

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: NGUYEN, MAGDALENE	FACILITY NUMBER: 434416469
	VISIT DATE: 03/16/2021

NARRATIVE

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Applicant states that the home does not have any wall heaters. LPA observed a barricaded fireplace in the Living Room and a fully charged 3A40BC fire extinguisher. The home has working smoke/carbon monoxide detectors (tested by Applicant during today's tele-inspection).

Cleaning compounds, medications, sharp objects, and similar items that are dangerous to children in care are stored inaccessible, out of reach of children. LPA reminded Applicant that all poisons must be locked by a combination lock or a key with lock.

LPA informed Applicant that smoking is prohibited in the home during daycare hours. Applicant understands and states that nobody smokes in the home. Applicant states that she does not have any baby walkers/inclined sleepers in the home and understands that baby walkers/inclined sleepers are not allowed in the home. Applicant states that she does not have any baby bouncers, jumpers, and saucer chairs in the home.

The refrigerator and freezer in the home are clean. No sharp utensils, lighter/matches, or open bottles of alcohol were observed. All cabinets in the kitchen are inaccessible to children. Applicant understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

LPA observed toilets and faucets are clean and operable. The shower is free of any hazards. No medications, mouthwash, perfumes, razors, cleaning products, air fresheners, and nail polish/remover were observed in the bathroom.

Applicant stated that a gate at the entrance of the premises is locked all the time and will be opened only during drop off time and pick up times during daycare hours. Off limit area outside the home: the entire backyard. There is a separate building on the backyard. The yard areas are fenced. The small yard area on the right side of the home is used for outdoor activity space. LPA observed a locked gate that prevents children from going to the off-limit backyard. Applicant understands that children must be supervised at all times while outdoors. No bodies of water were observed. Applicant states that there are no thorn trees.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021

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: NGUYEN, MAGDALENE	FACILITY NUMBER: 434416469
	VISIT DATE: 03/16/2021

NARRATIVE

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LPA reminded Applicant that children's personal rights should not be violated, no corporal punishment, fire/disaster drills must be practiced at least once every 6 months and documented and Mandated Child Abuse Reporting Training needs to be renewed every two years. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, and requirements for assistant/substitute were also discussed.

LPA reminded Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come 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.

LPA discussed "zero tolerance" related regulations with Applicant and advised her of 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.

Incidental Medical Services (IMS) policy was discussed. Applicant was provided the information regarding ADA: toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: http://www.ada.gov/childqanda.htm.

Applicant was informed that due to the current Covid-19 pandemic and "Shelter In Place" Order, the Facility Evaluation Report will be emailed to Applicant (email: srtuyet@gmail.com) with "Read Receipt" notification. Applicant understands that her reply to the email will serve as acknowledgement that the report was received.

LPA conducted an exit interview and advised Applicant that a large Family Child Care Home license will be approved upon receipt of the following:
1) A copy of Control of Property.
2) A photo of locked storage in off-limit backyard.
3) A photo of locked cabinet in laundry room.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021

LIC809 (FAS) - (06/04)

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