103900183-1-13-2023-04-CC-AGIN-CN2QDQ-20230113110507

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103900183
Report Date: 01/13/2023
Date Signed: 01/13/2023 11:05:12 AM

Document Has Been Signed on 01/13/2023 11:05 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	JAYNE, MYLA FAMILY CHILD CARE		FACILITY NUMBER:	103900183
ADMINISTRATOR:	JAYNE, MYLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 443-9446
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93611
CAPACITY:	14	CENSUS: 11	DATE:	01/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Myla Jayne		TIME COMPLETED:	11:15 AM

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On 01/13/23 Licensing Program Analyst (LPA), Araceli Gibson conducted an unannounced One Year Required Inspection and was met by Licensee, Myla Jayne and assistant hours of operation are Monday through Friday hours are 7:00 AM to 5:30 PM.

LPA toured the home inside and outside. Licensee had 11 children in care. Licensee confirmed that the living room, dining room, preschool room, child care bedroom, and bathroom, kitchen, and back yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of spinner knobs. Swimming pool is fenced per regulation. Licensee keeps a log of window alarm checks for compliance as bedroom window faces the pool area. Waiver in place for window facing pool so long as window alarm checked and documented once weekly. There are no firearms or ammunition on the premises. Detergents, poisons, cleaning compounds, medication and other hazardous items were inaccessible to daycare children.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a fireplace with an enclosure made inaccessible in the living room. Fireplace is not in use during day care hours. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 443-9446.

There are no infants enrolled. LPA discussed Safe Sleep Regulations with licensee. There should be one crib or play yard for each infant in care. Cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Infants up to 12 months of age are placed on their backs for sleeping. Licensee understands the use of the Infant Sleep LIC9227 form. Continue 809 C

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JAYNE, MYLA FAMILY CHILD CARE	FACILITY NUMBER: 103900183
	VISIT DATE: 01/13/2023

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LPA reviewed a sample of children’s files and observed files were complete with the immunizations. Licensee completed the Mandated Reporter Training on 3/17/21. Licensees’ pediatric CPR/First Aid expires on 07/2023. Currently Licensee had one employee present and was able to provide evidence of immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, No deficiencies cited during today’s inspection. Licensee was provided a copy of appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli Gibson	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC809 (FAS) - (06/04)

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