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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417391
Report Date: 02/01/2024
Date Signed: 02/01/2024 05:09:37 PM

Document Has Been Signed on 02/01/2024 05:09 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:PHAN, NGANFACILITY NUMBER:
434417391
ADMINISTRATOR:PHAN, NGANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 690-9099
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
02/01/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Ngan PhanTIME COMPLETED:
11:40 AM
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On 02/01/2024 at 8:40am, Licensing Program Analysts (LPAs), Farida Raja and Melvin Matos met with Applicant, Ngan Phan, to conduct an announced pre-licensing inspection. LPAs were granted access to the home by the Applicant and explained the purpose of today's inspection. Per Applicant, the adults that reside in the home are Applicant and six tenants (Thu Nguyen, Minh Nguyen, Nhung Diep - reside main home - and Thi To, Hau Nguyen, and Dat To - reside in the JADU). Licensee has four minor children residing in the home. The home is single story with 3 bedrooms and 2 bathrooms. The home has an attached JADU (converted garage) which has two bedrooms and one bathroom. Permits from the city of San Jose for the JADU are on file. Applicant states that she leases the home from the landlord and sub leases two bedrooms in the main home and the JADU (see above for list of tenants).

Days and hours of operation will be Monday - Friday from 8:00 AM- 6:00 PM. Applicant completed her Preventative Health and Safety Child Care Training on 12/06/2023 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 11/02/2025. Applicant has completed the Mandated Reporter Training for Child Care Workers on 11/07/2023. A copy of current TB test (Applicant and three tenants) are on file. Current MMR, Tdap and influenza vaccinations for the Applicant are on file.

Applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the Applicant confirms was provided to the property owner/landlord. The Applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). On review of the lease, it states that 'The premises shall be occupied by no more than five (5) persons, including children' but currently has 10 persons (six adults & four minor children) residing in the home. Lease also states that 'Tenant shall not allow other person(s)....to use or occupy the Premises without first obtaining Landlord's written consent to such use'. Applicant does not have written consent from the landlord to sub lease and allow tenants to occupy the premises. Applicant provided Landlord, Tung Nguyen's, phone number during today's inspection.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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: PHAN, NGAN
FACILITY NUMBER: 434417391
VISIT DATE: 02/01/2024
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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. One adult tenant, Nhung Diep, does not have criminal record and child abuse index clearances associated to the license.

Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). LPAs toured the indoor and outdoor areas of the home with the Applicant during today's inspection. Off limit areas inside the home two closets, master bedroom, master bathroom, two bedrooms, kitchen and entire JADU. LPAs inspected home for any health and safety hazards. Areas accessible to children were inspected to ensure that they are clean and orderly. There are sufficient toys, supplies, and equipment for the day care children. The floor is free of tripping hazards with toys placed in shelves. The home has central heating, wall mounted air conditioning unit, and ventilation for comfort of children.

LPAs observed a fireplace unit with a glass cover in the family room of the home. LPAs observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. LPAs observed toothpaste, air fresheners and cosmetics under the bathroom sink that were not inaccessible. On limit areas outside the home: Fenced covered patio area, adjacent to the family room area. Backyard is fenced and gated. Off limits area outdoors: left, right, and back portions of the backyard. Applicant understands that children must be supervised at all times while outdoors. There are no bodies of water observed.

Applicant has a working telephone in the home (408-690-9099). LPAs observed a fully charged fire extinguisher (2A10BC) in the dining area and working smoke and carbon monoxide detectors. LPAs informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented. Applicant states that she does not have any weapons/ammunition or pets in the home. Cleaning products, toxic agents, knives and sharp objects were stored inaccessible to children. LPAs reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. Applicant currently has several cots and one (1) crib available for napping.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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: PHAN, NGAN
FACILITY NUMBER: 434417391
VISIT DATE: 02/01/2024
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Applicant states that she will provide meals and snacks for the day care children. LPAs reminded the Applicant that any food/liquid products provided by parents will need to be labeled with each child's individual name(s). Filtered drinking water will be provided to children.


LPAs advised Applicant to have postings near the entrance so it is visible to parents/authorized representatives.Form of discipline to be used by the Applicant: time out. LPAs reminded applicant that time outs can only be one minute per age. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed.


LPAs discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPAs also informed applicant 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.

LPAs reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Applicant states that she will not provide transportation and LPAs reminded applicant that children cannot be left in parked vehicles unattended at any time.

Fire Inspection approval from the San Jose Fire Department for the operation of a large family child care home was received on 01/22/02024. Applicant submitted an updated Application for Family Child Care Home License (LIC 279) during today's inspection and added the additional tenants residing in the home.

Incidental Medical Services (IMS) policy was discussed. Applicant will wait until facility opens to determine IMS needs. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.


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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: PHAN, NGAN
FACILITY NUMBER: 434417391
VISIT DATE: 02/01/2024
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On this date, 01/31/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant, Ngan Phan. LPAs advised Applicant that a Large Family Child Care Home License will be approved upon completion of the following and supervisor approval.


  1. Submit proof of completion of tuberculosis test results (within past 12 months) for three adult tenants (Thi To, Hau Nguyen, and Dat To) living in the JADU.
  2. Proof of fingerprint clearance for one tenant living in the main home (Nhung Diep).
  3. Written consent letter from landlord to allow persons other that Applicant to occupy the premises.
  4. Updated lease agreement allowing premises to be occupied by more than five (5) persons including children.
  5. Make inaccessible or remove items from under hallway bathroom sink to make them inaccessible to children.
  6. Proof of removal of work tools from the on limit backyard area.
  7. Final review and approval by LPAs manager.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
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