103900183-10-13-2023-04-CC-MHEA-CWKTPR-20231013145444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103900183
Report Date: 10/13/2023
Date Signed: 10/13/2023 02:55:30 PM

Document Has Been Signed on 10/13/2023 02:55 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
FRESNO CC RO, 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: 10	DATE:	10/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Amy Wilson		TIME COMPLETED:	01:40 PM

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On 10/13/23 Licensing Program Analyst (LPA), Miguel Herrera conducted an unannounced Annual Required Inspection and was met by Assistant #1, and an assistant. Assistant #1 stated the licensee had a doctor’s appointment and would not be present during the inspection. The assistant confirmed that she was given permission by the licensee to conduct the inspection on her behalf and sign any required licensing reports. However, Licensee Myla Jayne arrived before the inspection was finalized. The hours of operation are Monday through Friday hours are 7:00 AM to 5:30 PM. The home has a working telephone service and LPA confirmed the phone number is (559) 443-9446. LPA toured the home inside and outside. Licensee had 10 children in care in which 1 of the ten children’s was an infant. Assistant confirmed that the living room, dining room, preschool room, child care room, 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. The licensee keeps a log of window alarm checks for compliance as living room window and sliding door faces the pool area. Waiver in place for window facing pool so long as window alarm checked and documented once weekly.

There is a built-in swimming pool in the backyard which is fenced and made inaccessible. The pool gate is self-latching, self-closing and opens away from the swimming pool. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is one fireplace in the home located in the living room and is made inaccessible by a screen and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. This is a single level home and there are no stairs. Safe toys and play equipment are observed.

To be continued on 809-C.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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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Document Has Been Signed on 10/13/2023 02:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JAYNE, MYLA FAMILY CHILD CARE	FACILITY NUMBER: 103900183
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above since licensee’s and assistant’s (#1) CPR/First Aid expired on 07/31/2023. Assistant #2 has a basic life support CPR on file that does not meet regulations which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2023
	Plan of Correction
1 2 3 4	Licensee states she will enroll in an approved CPR & First Aid training for her and her staff as soon as possible and will provide a copy of a current EMSA approved pediatric CPR & First Aid training Certificate by 10/27/2023 to Fresno RO via email/text.

Type B

Section Cited

CCR

102416.1(d)

Personnel Records

(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above since assistant #2’s file was missing. Assistant #2 was able to provide proof of her mandated reporter training by presenting LPA Herrera with an electronic certificate on her phone. LPA Herrera was unable to review assistant #2’s file with the required licensing forms and immunizations/TB clearance which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2023
	Plan of Correction
1 2 3 4	Licensee states she will ensure to submit assistant #2's file with all required licensing documents and immunizations/TB clearance to Fresno RO via email/text by 10/27/2023.

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: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JAYNE, MYLA FAMILY CHILD CARE	FACILITY NUMBER: 103900183
	VISIT DATE: 10/13/2023

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The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained. LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training expired on 3/17/2023. Licensee’s pediatric CPR/First Aid certification expired on 07/31/2023. Assistant #1’s Mandated Reporter Training expires on 5/12/2025. Licensee’s pediatric CPR/First Aid certification expired on 07/31/2023. Assistant #2’s Mandated Reporter Training expires on 5/08/2025. Assistant #2’s CPR/First Aid certification does not meet regulation requirements as she’s only certified for basic life support. A review of records indicates that licensee and assistant #1 have immunization records on file for influenza, pertussis, and measles. LPA Herrera was unable to review assistant #2’s file for required licensing forms and immunizations. Per Assistant #1 she was unable to find the file and licensee was unable to provide her guidance as to where the file was located.

The assistant understands that there shall be one play yard for each infant in care, the play yard should be kept free from all loose articles and objects while infants are sleeping, and there shouldn’t be objects hanging above or attached to the play yard. Assistant states that infants are not swaddled while in care. Assistant states infants can come out a play yard/crib therefore the infant sleeps in a sleeping mat. Upon record review LPA Herrera observed that infant’s file had a missing 15-minute sleeping log. Infant was enrolled on 09/01/2023 and is two weeks short of turning 2 years old. LPA Herrera reminded assistant Wilson about infant safe sleep regulations and the 15 minute safe sleep logs for all infants under 24 months old. Licensee will ensure to document safe sleep logs for child #1 until he turns 2 years old.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

Licensee was reminded that all adults 18 and over living or working in the home, 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.

Continued on 809-C.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JAYNE, MYLA FAMILY CHILD CARE	FACILITY NUMBER: 103900183
	VISIT DATE: 10/13/2023

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LPA discussed safe sleep regulations with the assistant 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 licensee 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with Licensee. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see LIC 809-D).

Licensee was provided 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: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC809 (FAS) - (06/04)

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