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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625415
Report Date: 03/04/2026
Date Signed: 08/05/2026 08:28:15 AM

Document Has Been Signed on 08/05/2026 08:28 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 DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:TA, XUAN & NGUYEN, NHUT FAMILY CHILD CAREFACILITY NUMBER:
376625415
ADMINISTRATOR/
DIRECTOR:		XUAN TA & NHUT NGUYENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 452-8521
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 4DATE:
03/04/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Diane Ta and Christine NguyenTIME VISIT/
INSPECTION COMPLETED:
07:00 PM
NARRATIVE
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On 03/04/26 at 2:45 PM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with substitute assistant today, Diane Ta, and licensee daughter-in-law and home resident, Christine Nguyen. Ms. Ta is a former licensee who, while she still has active clearances in the system, was caring for children without having those clearances associated to the facility license. Licensee Xuan Ta has left the city due to a family emergency and Diane Ta is working as a substitute for her until her return. Nhut Nguyen is no longer actively working in the child care. Mr. Nguyen arrived at the home towards the end of the inspection.

LPA disclosed the purpose of the inspection and was granted entry into the facility Ms. Ta and Ms. Nguyen. Five (5) children including the licensee's grandson were in the home today. However, the licensee's grandson is not part of the day care as he is under the direct supervision at all times of his mother, the cleared and associated Christine Nguyen. This facility is a one floor, five bedroom, two bathroom house. Licensee assistant accompanied LPA inside of the facility during this inspection.

The following areas used for child care are: the living room, the family room and the day care bathroom. Off limits areas are the kitchen, the five home bedrooms, the second bathroom and the garage. The kitchen is made off limits with installed safety gated at both entrances. The day care bathroom is off the kitchen, however, the licensee and any caregivers escort children to the restroom when needed. The first two bedrooms and the second bathroom are in a separate portion of the home and are made off limits with a locking entry door. The remaining three bedrooms are made off limits with their own locking door handles. The garage is made of limits with an entry way door that leads into it that has a highly placed dead bolt lock on it. The home has a fenced backyard which is now to be off limits for the day care children due to the licensees keeping personal items in it. Licensees will take children to a local park whenever outdoor activity is required. The yard is made off limits with a sliding, latching glass door.
Rajani Goudreau
Luigi Gargaro
DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE
FACILITY NUMBER: 376625415
VISIT DATE: 03/04/2026
NARRATIVE
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Licensees' First Aid and CPR certifications expire on 07/20/26 but Diane Ta, who was left with the children today, did not have proof of current certifications or required immunizations. Co-licensees are currently exempt from Mandated Reporter Training. Hard copy of facility roster is not maintained. The last fire and disaster drills were not conducted and documented in the last six moths as required. Licensees currently have no infants in care but analyst provided the with a copy of the safe sleep regulations to review at a future date.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: [email protected] . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248. Unusual Incident Reports may be e-mailed to: [email protected]

Incidental Medical services (IMS) policy was discussed. 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.

One type A and five type B violations California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D .Upon Receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted with the co-licensee, Nhut Nguyen. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.
NAME OF LICENSING PROGRAM MANAGER: Rajani Goudreau
NAME OF LICENSING PROGRAM ANALYST: Luigi Gargaro
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/05/2026 08:28 AM - It Cannot Be Edited


Created By: Luigi Gargaro On 03/04/2026 at 04:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE
FACILITY NUMBER: 376625415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst interview and record review, the licensee did not comply with the section cited above as her sister, Diane Ta, was caring for the children today without an associated criminal record clearance which poses an immediate health, safety or personal rights risk to children in care.
POC Due Date: 03/04/2026
Plan of Correction
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Ms. Ta is a former licensee who, while she still has active clearances in the system, was caring for children without having those clearances associated to the facility license. Licensee Xuan Ta has left the city due to a family emergency and Diane Ta is working as a substitute for her until her return. Ms. Ta started working at the facility today. Analyst will transfer her clearances to the facility upon return to the office to correct the deficiency.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Rajani Goudreau
NAME OF LICENSING PROGRAM MANAGER:
Luigi Gargaro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/05/2026 08:28 AM - It Cannot Be Edited


Created By: Luigi Gargaro On 03/04/2026 at 04:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE
FACILITY NUMBER: 376625415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst observation, the licensee did not comply with the section cited above as several supplements and medications were found within in reach of children on a kitchen counter that overlapped into the living room and on a day care table which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 03/04/2026
Plan of Correction
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Licensee assistant, Diane Ta, removed all items during visit and placed them in an inaccesible cabinet to correct the deficiency during today's visit. Violation cited as a Type B violation as all items were sealed and there was sufficient supervision for the four children in care today.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst record review, licensee did not comply with the section cited above as licensee assistant, Diane Ta, did not have proof of immunizations available for review during today's visit which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 03/09/2026
Plan of Correction
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Assistant Diane Ta is a former licensee and states has had required immunizations. Licensee states she will obtain copies of those immunizations and send copies of them to analyst by 03/09/26 to correct the deficiency. Licensee also states she will maintain a copy of them at this facility when she is substituting for the licensee or assisting at the facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Rajani Goudreau
NAME OF LICENSING PROGRAM MANAGER:
Luigi Gargaro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/05/2026 08:28 AM - It Cannot Be Edited


Created By: Luigi Gargaro On 03/04/2026 at 04:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE
FACILITY NUMBER: 376625415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst record review, the licensee assistant, Diane Ta, did not comply with the section cited above as she did not have a copy of current CPR/Frist Aid certifications which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 04/06/2026
Plan of Correction
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Licensee has until 04/06/26 within which to obtain current EMSA approved CPR/First Aid certifications and then send analyst a copy of them to correct the deficiency.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst record review, licensee did not comply with the section cited above for four out of four children files as they were missing almost all the required forms, including the Emergency Identification Form, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 04/06/2026
Plan of Correction
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Licensee assistant, Diane Ta, was provided a blank children's record packet and states she will have the parents complete them and then send copies of the completed records for all children by 04/06/26 to correct the deficiency.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Rajani Goudreau
NAME OF LICENSING PROGRAM MANAGER:
Luigi Gargaro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2026


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 08/05/2026 08:28 AM - It Cannot Be Edited


Created By: Luigi Gargaro On 03/04/2026 at 04:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: TA, XUAN & NGUYEN, NHUT FAMILY CHILD CARE
FACILITY NUMBER: 376625415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on analyst record review, the licensee did not comply with the section cited above as she did not have a facility roster which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 03/16/2026
Plan of Correction
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3
4
Licensee assistant, Diane Ta, was provided with a blank facility roster and states she will complete it and send a copy to analyst by 03/16/26 to correct the deficiency.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Rajani Goudreau
NAME OF LICENSING PROGRAM MANAGER:
Luigi Gargaro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2026


LIC809 (FAS) - (06/04)
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