574500222-6-15-2021-53-CC-MSOO-C3ZUPW-20210615154614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 574500222
Report Date: 06/15/2021
Date Signed: 06/15/2021 03:46:20 PM

Document Has Been Signed on 06/15/2021 03:46 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	TRUONG, KIM LEE		FACILITY NUMBER:	574500222
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	06/15/2021
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:57 PM
MET WITH:	Kim Lee Truong		TIME COMPLETED:	04:00 PM

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On June 15, 2021, at 1:57pm, Licensing Program Analyst (LPA), Marissa Soto met with Licensee, Kim Truong for an unannounced Annual inspection. Present in the home was Licensee Kim supervising 4 children. (Age: 2 years old, 2 years old, 3 years old, and 8 months). Licensee stated there are no new residents in the home since licensure, Home is 2 story, 3 bedrooms, 2.5 bathrooms. Day care hours of operation are Sunday-Saturday 24 hrs year round with periodic breaks through the year. Licensee understand that care cannot exceed more than 24 hrs in a day. All adults living in the home have criminal background clearance.
A health and safety inspection was conducted in all areas accessible to children and the following was observed, living room, kitchen, bathroom the children utilize, and upstairs loft; Off-limits areas are: All bedrooms, laundry room, and garage. LPA observed hazardous items properly stored out of child reach on high shelves in kitchen/laundry room area. There were no hazardous items located in the bathroom. Medication are stored in a lock box made inaccessible to children. Fire extinguisher, smoke and carbon monoxide detectors are functional. Toys appear to be safe and age appropriate. There were no bodies of water on the property.

A sample of children’s files were reviewed and determined to be in compliance with licensing requirements. A current roster is being maintained and fire and disaster drills are conducted at least once every six months and are documented on a sheet. Current pediatric CPR and first aid certification was verified and expires on 06/2021.

LPA discussed the California Child Care Worker: Mandated Reporter Training with the licensee. The licensee must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be found at: mandatedreporterca.com.

Report continues on 809-C

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Marissa Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: TRUONG, KIM LEE	FACILITY NUMBER: 574500222
	VISIT DATE: 06/15/2021

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LPA also discussed the Smoking ban, Licensee acknowledged that the home is smoke free. Incidental Medical Services (IMS) policies were also discussed with the licensee. LPA discussed immunization requirements with the licensee. This provider is currently not providing IMS services to children in care. IMS policy was discussed with Licensee. 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.

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: http://www.ada.gov/childqanda.htm.

Lead Poisoning Facts Information Flyer was provided and Licensee was advised that beginning January 1, 2019 a new law (AB 2370) requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.

LPA advised the licensee on Safe Sleep Practices and SIDS; the licensee stated they are understood. She stated she uses play yards for sleeping infants and understand infants cannot sleep in car seats, swings or other items not intended for sleeping. LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. Appeal rights provided during today's visit.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Marissa Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

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