198021303-6-4-2024-33-CC-KLOG-D5WQDY-20240604120530

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021303
Report Date: 06/04/2024
Date Signed: 06/04/2024 12:05:35 PM

Document Has Been Signed on 06/04/2024 12:05 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	NGUYEN FAMILY CHILD CARE		FACILITY NUMBER:	198021303
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	06/04/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:55 AM
MET WITH:	Cathy Nguyen, Licensee		TIME VISIT/ INSPECTION 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) Kruz Long conducted an announced case- management licensee-initiated inspection to the above facility on 06/04/24 due to licensee is requesting capacity increase. Upon arrival, LPA met with licensee, Cathy Nguyen who guided analyst on a tour of the facility. A COVID 19 risk assessment was conducted prior to entering the facility. Also present during this inspection was Licensee’s Assistant (Phillip Pak) and 6 children. Per licensee, facility hours are Monday to Friday from 8:00 a.m. to 5:30 p.m. Fire Clearance for Large Family Child Care Home was granted on 05/30/2024. All areas identified on the facility sketch was inspected, including but not limited to, all off limit areas. This is a two-story home that consists of 3 bedrooms, 2 bathrooms, kitchen, living room, dining room, and garage. Main care is provided in the first floor containing a living room, dining area, bathroom, and rear yard. Off limit areas: Second floor and garage. (Barrier at the bottom of the stairs was observed) The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per applicant there are no pets, no weapons or firearms on the premise. The home is clean and well ventilated. There are age appropriate toys (blocks, dramatic play area, slides, kitchen set). Age appropriate napping equipment (cots and playpens). Smoke/Carbon Monoxide detectors located in the dining area is operable. The required fire extinguisher (2A10BC) is fully charged. Home has central AC and heat. CPR/First Aid expire on 08/17/25. Children will sleep on the cots and playpens. Breakfast, lunch and snacks will be provided. Parents/Guardians will drop off and pick up children through the front entrance. The home contains a cell phone. Cleaning compounds and knives are locked in the kitchen cabinets. Last drill documented was conducted on 05/30/24. page 1 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NGUYEN FAMILY CHILD CARE	FACILITY NUMBER: 198021303
	VISIT DATE: 06/04/2024

NARRATIVE

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NFANT CARE: Licensee states that infants sleep in the living room. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age.

Medication: Incidental Medical Services (IMS) policy was discussed. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and a copy of this report and appeal rights was provided to the Licensee.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

LIC809 (FAS) - (06/04)

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