<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010145
Report Date: 06/25/2025
Date Signed: 06/25/2025 01:31:59 PM

Document Has Been Signed on 06/25/2025 01:31 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:NGUYEN, HOANG & MATTHEW FCCHFACILITY NUMBER:
493010145
ADMINISTRATOR/
DIRECTOR:
NGUYEN, HOANG & MATTHEWFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 303-6417
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
06/25/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:14 AM
MET WITH:Matthew and Hoang "Kim" NguyenTIME VISIT/
INSPECTION COMPLETED:
12:45 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
An unannounced visit was made to the facility today by Licensing Program Analyst (LPA) Y. Yang. A review of staff records on 06/25/2025 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. There are currently two adults living in the home.

During today’s inspection the home and grounds were toured. Both licensees were present and supervising seven children and operating within ratio. The facility’s operating hours are 07:30am to 05:30pm, Monday through Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home were made inaccessible by door locks and/or child gates. The home's staircase was inaccessible. Children are supervised in a gated childcare area in the living room. The home was at a comfortable indoor temperature. The home's fireplaces are screened using a sheet of plywood. There were safe toys and equipment available for children. The licensees stated there is a working telephone in the home. The licensees' pediatric CPR and First Aid certificates and CA mandated reporter training certificates expire in November 2025. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. The LPA observed a working smoke detector, carbon monoxide detector, and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated that poisons, firearms, and ammunition are not stored on the premises. The backyard is currently off limits and not used for childcare due to construction. The licensees stated that they will notify the Department once construction is completed to have the backyard reinspected and approved for childcare use. There were no bodies of water observed during today's inspection. Five children's record were reviewed during the inspection and contained items as required in the inspection checklist such as infant nap check logs, immunization logs, and signed parent's rights notification documents. The LPA reviewed two personnel files. Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Yang Yang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2025
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