Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376621055
Report Date: 02/15/2018
Date Signed 02/15/2018 01:54:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:TA, THUY & DOAN, KHANH FAMILY CHILD CAREFACILITY NUMBER:
376621055
ADMINISTRATOR:THUY & KHANHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 271-4977
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:14CENSUS: 7DATE:
02/15/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Thuy Ta and Doan KhanhTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Farah Tanous conducted an unannounced Annual Random inspection at the facility. Upon arrival, LPA met with Licensee, Thuy Ta, and her husband/assistant, Meng Doan, who were supervising 7 daycare children, 3 of whom were infants. Proper accommodation was provided to the infants as each infant was napping in a play pen. LPA used LanguageLink translation service to assist with Vietnamese translation (ID# 11609). At 1:20PM co-licensee, Khanh Doan (Mrs. Ta's son) arrived at the facility and LPA was able to conduct the rest of the inspection in English with co-licensee Khanh Doan. LPA toured/inspected the facility inside and outside as per facility sketch. The following areas are used for day care: living room, kitchen, family room, all three bedrooms and two bathrooms. Licensees utilize a fully fenced back yard area for outdoor activities. The following areas are off limits: the garage which is made inaccessible via a lock. LPA did not observe bodies of water during this inspection.

There is a functioning smoke alarm, carbon monoxide detector, & fire extinguisher maintained in the home. There are ample space and napping areas for children. The home has adequate heating and ventilation. The home has a working telephone. Licensee stated no changes to the LIC610A dated 08/31/2009. The Last disaster drill was conducted on 09/04/2017. Licensee stated there are no weapons on premises. Licensee stated that there are no new adults living or working in the home over the age of 18 years. Licensees have CPR & first aid certification valid through January 15th, 2019.

LPA reviewed the following with Licensee: Capacity limitations, supervision, unusual incidents, mandated reporting, Assembly Bill 633, SIDS, Shaken Baby Syndrome, Megan's law, AB 2084 Healthy Beverages in Child Care. Licensee is reminded that corporal punishment, smoking, baby walkers, exersaucers, jumpers and bouncy seats shall never be permitted during day-care operation. Licensee is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children. Some Children's records were reviewed. LPA obtained a copy of children's Roster and an updated email address and cell phone number for co-licensee.

SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Farah TanousTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2018
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: TA, THUY & DOAN, KHANH FAMILY CHILD CARE
FACILITY NUMBER: 376621055
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2018
Section Cited
HSC
1597.622(a)(1)
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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.
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Licensee (Mr. Doan) states that he will obtain all the immunizations needed and will submit documentation as proof of correction 03/22/2018.
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Both Licensees and assistant (Meng Doan) were unable to provide documentation of immunizations per SB792.
This poses a potential Health & Safety risk of clients in care.
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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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Farah TanousTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2018
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: TA, THUY & DOAN, KHANH FAMILY CHILD CARE
FACILITY NUMBER: 376621055
VISIT DATE: 02/15/2018
NARRATIVE
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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

During today’s inspection, LPA discussed with Mr. Khanh Doan Assembly Bill 1207 (Lopez), Chapter 414, Statutes of 2015 (Mandated Child Abuse Reporting). Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Licensee understands that she shall meet the requirement by March, 30, 2018 or a deficiency will be issued.

Following deficiency was observed during today's inspection:
  • Facility does not maintain immunization records for both licensees and Mr. Meng Doan (Mrs. Ta's husband/helper) as per (SB792) for: pertussis, measles, and influenza.

See LIC809D for cited deficiencies. LPA provided Notice of Site Visit (LIC 9213). LPA observed Licensee post the LIC9213 and it shall remain posted for the next 30 days. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Exit Interview conducted. Access our updated Regulation & Forms by using our WEBSITE: http://www.ccld.ca.gov Office: (619) 767-2200, Open Monday thru Friday 8am-5pm.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Farah TanousTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2018
LIC809 (FAS) - (06/04)
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