Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002528
Report Date: 06/21/2017
Date Signed 06/21/2017 01:26:21 PM

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:LUONG, NGOC KHANHFACILITY NUMBER:
384002528
ADMINISTRATOR:LUONG, NGOC KHANHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 418-4834
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:14CENSUS: 6DATE:
06/21/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ngoc LuongTIME COMPLETED:
11:50 PM
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Licensing Program Analyst (LPA) Leung conducted an Annual inspection with licensee, Ngoc Luong (dba SOMA Day Care). Present were 6 children including 2 of Licensee's own children and 2 helpers. LPA inspected the day care area for health and safety hazards. Licensee, her husband and two children live in this flat. Child care area are the first two rooms on the right (living room and dining room facing the front), they are set up like a play room and for main activity; children's bathroom is across from the kitchen. Children go to the back yard for outdoor activity. Off-limit areas are the Licensee's bedroom, bathroom next to this bedroom, daughter's bedroom. Mats are available for napping. Children's cubbies are in the hallway. Plenty of toys and books were available in the play room. There are smoke/ carbon monoxide detectors in the house. First aid supplies are available. Fire extinguishers are charged. Gates are available to block off the outside stairways. Facility prepares snacks, breakfast and lunch for children. There are no pets in the house. Last fire/ emergency drill was done on March 13, 2017. Licensee has her first aid/ CPR certificates good till, July, 2018.

Licensee informed Licensing an outbreak of croup starting over the last weekend. Three children had been treated for croup. A coughing usually last 3 - 5 days, it started with a fever. One child is still out due to the illness.

Licensee has informed about the new immunization requirement for all child care providers which include measles shot, flu shot and Pertussis shot record.

This report and a Notice of Site Visit are provided to Ms. Luong.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2017
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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