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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421124
Report Date: 08/10/2022
Date Signed: 08/10/2022 04:14:33 PM

Document Has Been Signed on 08/10/2022 04:14 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PHAN, HANGFACILITY NUMBER:
013421124
ADMINISTRATOR:PHAN, HANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 305-7483
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
08/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Hang PhanTIME COMPLETED:
04:30 PM
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On 08/10/2022 approximately at 1:05PM Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Hang Phan. Present for this inspection was licensee, licensee's fingerprinted and associated parents along with two staff members, and 9 preschool aged children and 2 infants. Licensee also has a school aged (13 years old) daughter who resides with her and sometimes her fingerprinted adult daughter resides at the facility. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:00am to 6:00pm.

ON LIMITS: hallway bathroom, kitchen, eating area, living room (play room), and office (isolation area)
OFF LIMITS: garage, front and back yard, and 3 bedrooms. Off limit areas are inaccessible by closed and/or locked doors, and visual supervision.

The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. At 1:15PM, LPA observed there were ample age appropriate toys that were observed to be safe and in good condition. There were no toxins, medicines, and hazardous items were inaccessible during today's inspection. There were a 3A40BC fire extinguisher, working carbon monoxide, smoke detectors, and telephone. The home has a fireplace but is blocked off by a barrier. Per licensee, there are no firearms or any bodies of water in the home. Facility does have a small dog. The licensee conducts and documents fire drill log indicates a drill was conducted 06/04/22. All required licensing documents are posted and visible for public review. At 1:40PM, LPA observed the office room that is being used for sleeping infants and as an isolation area and reminded licensee to keep door open while sleeping children are inside as she may hinder her sight and sound of the sleeping child. Licensee understood. Sleep logs are also discussed and will email or mail a copy to licensee or suggests to licensee that she may create her own version of the sleep log. LIC 9227 (Individualized Sleep Plan) was also discussed.

SEE LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PHAN, HANG
FACILITY NUMBER: 013421124
VISIT DATE: 08/10/2022
NARRATIVE
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At 1:50pm, 6 children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. Licensee does not have proof of the required immunization, however she would send LPA a copy of immunizations via email. The licensee and staff members have required mandated reporter training that is completed as of 03/05/2021 and 10/09/2021. Both licensee and staff members have CPR and First Aid training completed as of 06/12/2021 and is valid for 2 years. Licensee has liability insurance from Child, INC and Mercury that has maximum coverage, therefore LIC 282 is not required for children files.

There were no deficiencies were cited for today's inspection

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with licensee Hang Phan

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.

SEE LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PHAN, HANG
FACILITY NUMBER: 013421124
VISIT DATE: 08/10/2022
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Incidental Medical Services (IMS) policy was discussed. This facility does not provides IMS to children in care 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.”


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.


Licensee was reminded that California Law requires licensed Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

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 inspectionprocess@dss.ca.gov. 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.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
LIC809 (FAS) - (06/04)
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