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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103910292
Report Date: 11/15/2019
Date Signed: 11/15/2019 02:44:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MASSEY, DAWNA FAMILY CHILD CAREFACILITY NUMBER:
103910292
ADMINISTRATOR:MASSEY, DAWNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 709-6195
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:14CENSUS: 10DATE:
11/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Assistant - Amanda AlvarezTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA), Luisa Gavoutian, conducted an unannounced annual inspection. LPA was greeted by Assistant Amanda Alvarez who accompanied LPA on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Also present was fingerprint-cleared assistant Patricia Swofford. Licensee was not present during today’s inspection. Present during today’s inspection were ten children. The areas of the home that are accessible to the daycare children are the living room, dining room, kitchen, daycare room, daycare bedroom, hallway bathroom, and fenced backyard. “Off-limits” rooms are made inaccessible by door knob spinners and hook and eye latch. Three dogs were observed during today’s inspection, which are kept inaccessible to children; Licensee is aware of the safety of children around animals. There are no "bodies of water" in this home. Assistant Amanda stated there are no firearms in this home. Assistant Amanda stated there are no poisons on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children by glass window. There is a working fire extinguisher. LPA tested the smoke detector and carbon monoxide indicator, which were both in working condition. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the home.

There is a working telephone and cellphone number was verified. Adequate supervision is being provided during this visit. Children are supervised when outside in the play area. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. Licensee maintains documentation of immunizations for herself and staff. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Fire drills are conducted and documented with the date and time every six months. Licensee is aware that children are never to be left in parked vehicles.

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. (Continued on next page, LIC809-C)

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MASSEY, DAWNA FAMILY CHILD CARE
FACILITY NUMBER: 103910292
VISIT DATE: 11/15/2019
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Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care.

Pediatric CPR/First Aid are current expiring on 06/24/2021. Mandated reporter certificate is current, expiring on 01/22/2020. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advanced notice. Days and hours of operation are Monday – Friday; 7:30 AM – 5:30 PM.

LPA discussed Incidental Medical Services (IMS) and left the Plan for Providing Incidental Medical Services (IMS) – FCCH Requirements. 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.



LPA & Assistant Amanda discussed the Community Care Licensing (CCL) website: LPA and Assistant Amanda discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN. LPA thoroughly discussed safe sleep practices and left a copy of “Safe Sleep in Child Care.” LPA provided Assistant Amanda with the “Effects of Lead Exposure” brochure with instructions to distribute to all parents/authorized representatives.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2