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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417445
Report Date: 12/27/2024
Date Signed: 12/27/2024 11:13:39 AM

Document Has Been Signed on 12/27/2024 11:13 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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:TRAN, VIVIANFACILITY NUMBER:
434417445
ADMINISTRATOR/
DIRECTOR:		VIVIAN TRANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 382-9427
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/27/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:52 AM
MET WITH:Vivian TranTIME VISIT/
INSPECTION COMPLETED:
11:28 AM
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On 12/27/2024, at 8:52 AM, Licensing Program Analysts (LPAs) Andy Yang and Syeda Bahar, met with Applicant, Vivian Tran to conduct an announced pre-licensing inspection for large family care home due to change of location. Present for this inspection are Applicant, and (1) Child (son). The home was toured to conduct a Health and Safety Inspection. Days and hours of operation are from Monday to Friday 7:00 AM to 6:00 PM. Children enrollment range is from 0 to 13 years old. Fire clearance has been approved on 11/22/2024 for on limit areas of living room, kitchen, dining area, bathroom, room 1, room 2, room 3 (master bedroom), master bathroom, entire backyard, and the garage as off limit. Applicant decided to put the master bedroom, master bathroom, room 2, and left side yard (backyard) as off limit. Applicant provided updated facility sketch LIC 999 at time of inspection.

The home is single family home. The home consists of living room, kitchen, dining area, bathroom, room 1, room 2, room 3 (master bedroom), master bathroom, garage, and backyard including two side yards. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are living room, kitchen, dining area, bathroom, room 1, backyard, and right side yard. The OFF LIMIT AREAS are garage, master bedroom, master bathroom, room 2, and left side yard (which is barricaded) which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be room 1. The outdoor play area is free from defects or dangerous conditions and is fenced. There are ample age-appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs, or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children, and it was observed that there are no toxins or hazardous items accessible today. Applicant states that any poisons are stored in garage which is OFF LIMITS. LPA reminded Applicant that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: TRAN, VIVIAN
FACILITY NUMBER: 434417445
VISIT DATE: 12/27/2024
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The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The Applicant CPR and First Aid certificate is current and expires 12/30/2025. Applicant completed the Mandated Reporter Training for Child Care Providers on 2/01/2024 (expires 2/2026) and a copy of the certification is on file. Applicant was reminded of Mandated reporter Training (AB1207) and CPR/First aid certifications needs to be renewed every two years. A copy of the Applicant’s immunization is on file. Per Applicant, there are no firearms in the home.

Applicant states that she will not administer any medication to the children at this time. Applicant states that a child will be isolated in the ISOLATED AREA if necessary due to illness or communicable disease. Applicant has a First Aid kit with a touchless thermometer in the home. Also discussed with Applicant the requirements for reporting suspected child abuse, unusual incidents/injuries, and heat related illnesses.

Forms of discipline to be used by Applicant are talking and redirecting. Applicant understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, children are treated with dignity, receive safe, healthful, and comfortable accommodations, interference with eating, intimidation, or other actions of a punitive nature. LPA informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

The Applicant provided proof of control of property with a deed of trust which is under her husband, Edward Chin. LPA stated that since the Applicant is not on the deed, she will need to complete the Property Owner/Landlord Notification form LIC 9151. Applicant provided completed Landlord Notification form LIC 9151 at time of inspection. Applicant stated that she will enroll in day-care insurance. LPA stated that if applicant does not have liability insurance, she will need to issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) to all enrolling families until she obtains liability insurance in the future.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: TRAN, VIVIAN
FACILITY NUMBER: 434417445
VISIT DATE: 12/27/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (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.

Applicant, Vivian Tran was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA reviewed with the Applicant, the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Pre-licensing Entrance Checklist – Family Child Care Homes (LIC 9280) was provided to the Applicant.

LPA discussed the safe sleep regulations with Applicant, Vivian Tran, and discussed the Child Care Licensing Safe Sleep webpage at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed Applicant 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.



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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: TRAN, VIVIAN
FACILITY NUMBER: 434417445
VISIT DATE: 12/27/2024
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On this date, 10/22/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant, Vivian Tran. LPA advised the Applicant that a Large Family Child Care Home license will be approved pending Licensing Program Manager’s review.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4