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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505659
Report Date: 05/13/2022
Date Signed: 05/13/2022 12:34:42 PM

Document Has Been Signed on 05/13/2022 12:34 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:QUACH, NGOC TRAN & TRUONG, HUE LINHFACILITY NUMBER:
380505659
ADMINISTRATOR:QUACH, NGOC TRANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 759-5181
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
05/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Hue Linh TruongTIME COMPLETED:
12:45 PM
NARRATIVE
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 On May 13, 2022, Licensing Program Analyst (LPA) Van performed an annual 1-year mandatory inspection, which included checking the interior and exterior of the facility and discussing the required childcare paperwork with the Licensee. Linh Hue Truong, the Licensee, was greeted by the LPA, who explained the objective of the inspection. Co-Licensee Ngoc Tran Quach was not present. The Licensee stated the facility is currently closed due to COVID exposure of one of the Licensee's family members. As a precautious measure, the facility closed and will resume on Monday, 5/16. LPA discussed the reporting requirements and informed the Licensee to contact Licensing to report the incident. Every adult living and working in the home has a criminal record clearance on file. The Licensee owns this two-story, single-family home. Daycare is on the ground level, including two playrooms, a nap room, and a bathroom. Off limit areas are the entire second floor, garage, and backyard. Current home residents are both licensees (mother and daughter) and their husbands.
LPA reviewed and inspected the Licensee's home for health and safety hazards. The child care areas of the house to be in good condition, with appropriate temperature and ventilation. The facility offered a good selection of age-appropriate toys and equipment. During the physical plant inspection, LPA observed cleaning products such as Lysol in the bathroom, accessible to children. Since no children were present at the daycare, a Technical Violation was issued. LPA informed Licensee that all cleaning products and disinfectants should be stored inaccessible to children. In addition, LPA observed a power surge and electrical cords hanging from the power surge next to the handwashing sink. LPA informed the Licensee to install a power surger cover or electrical cords concealer to prevent children from accessing them.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 05/13/2022 12:34 PM - It Cannot Be Edited


Created By: Brendon Van On 05/13/2022 at 10:58 AM
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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: QUACH, NGOC TRAN & TRUONG, HUE LINH
FACILITY NUMBER: 380505659

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, both Licensees did not comply with the section cited above. Both Licensees have not completed their Mandated reporter training, which poses/posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 05/27/2022
Plan of Correction
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The Licensee states she will ensure that all current or new staff members complete the mandated reporter training every two years. The Licensee says she will have all staff complete the training by May 27. A return visit is necessary.
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 record review, the facility did not comply with the section cited above in 1 out of 2 staff had their Pediatric FirstAid CPR expired, which poses/posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 05/27/2022
Plan of Correction
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The Licensee states she will ensure that all staff at least register for the CPR course and possibly complete the Pediatric FirstAid/CPR by May 27, 2022. Once the CPR is completed, she will submit the certificate to Licensing.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/13/2022 12:34 PM - It Cannot Be Edited


Created By: Brendon Van On 05/13/2022 at 10:58 AM
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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: QUACH, NGOC TRAN & TRUONG, HUE LINH
FACILITY NUMBER: 380505659

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Licensees did not comply with the section cited above. Both licensees did not have immunization records on file or records available for review, which poses/posed a potential health, safety, or personal rights risk for persons in care.
POC Due Date: 05/27/2022
Plan of Correction
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Licensees must ensure that immunization records are kept at the facility and available for review upon request. The Licensee states she and her co-licensee will follow up with their doctor, request the record, and have it available by May 27.
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.
SUPERVISOR'S NAME:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2022


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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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: QUACH, NGOC TRAN & TRUONG, HUE LINH
FACILITY NUMBER: 380505659
VISIT DATE: 05/13/2022
NARRATIVE
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 The house has a fully charged fire extinguisher, smoke and carbon monoxide detectors, and a functional phone. The facility has a fully stocked first aid kit available for children. There were no pools, spas, or bodies of water on the site.
LPA reviewed Licensee's record, and no children's records were reviewed. LPA provided the annual checklist to the Licensee and discussed with the Licensee the records/Licensing forms that are required for each child. One of the co-Licensees, Pediatric FirstAid CPR, expired in November 2019. In addition, both Licensees' did not keep records of immunizations and Mandated Reporter Training AB 1207 or have the records available for review.
The Licensee stated fire and earthquake drills are conducted once every three months. The most recent fire & earthquake drill was held on March 21, 2022. The Licensee did not have the Parent's Rights poster or Earthquake Preparedness Checklist posted. LPA reminded the Licensee of the required posting, and during the visit, Licensee downloaded the required forms and posted.
During the inspection, the following was discussed and provided to the Licensee
· The Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulations, Receiving Important Updates, and Lead Poisoning Facts Flyer. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.
· The Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
· The Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
· LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
· LPA discussed care and supervision with the Licensee. Capacity options were reviewed, and the Licensee acknowledges that care cannot be provided over the capacity specified on the license.
· For any additional questions, the Licensee was advised to contact the CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
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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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: QUACH, NGOC TRAN & TRUONG, HUE LINH
FACILITY NUMBER: 380505659
VISIT DATE: 05/13/2022
NARRATIVE
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 Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
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: www.ada.gov/childqanda.htm.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee 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.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
See the attached deficiencies page for deficiencies issued today under Title 22 Division 12 of the Ca. Code of Regulations.
The report was reviewed and signed by Licensee Linh Hue Truong. This report and rights to comment and appeal have been discussed with the Licensee. Today's report, 5/13/2022, site visit notice, deficiencies, and appeal rights will be sent to Linh Hue Truong by email on 5/13/2022. Confirmation of receipt is required, and a site visit notice must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
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