<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103910292
Report Date: 12/08/2022
Date Signed: 12/08/2022 11:21:18 AM


Document Has Been Signed on 12/08/2022 11:21 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:MASSEY, DAWNA FAMILY CHILD CAREFACILITY NUMBER:
103910292
ADMINISTRATOR:MASSEY, DAWNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 709-6195
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:14CENSUS: 9DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dawna Massey TIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/08/2022 Licensing Program Analyst (LPA), Araceli Gibson conducted an unannounced One Year Required Inspection and was met by Licensee, Dawna Massey and 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 9 children in care. Licensee confirmed that the living room, daycare room, dining room, kitchen, bathroom, bedroom 1 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 safety gates and locked doors. There is small pond at the entrance of the daycare fenced per regulation. The gate is self-latching, self-closing and opens away from the pond. There are no firearms or ammunition on the premises. Detergents, poisons, cleaning compounds, medication and other hazardous items were made 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 is blocked by screen making it inaccessible in the daycare 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) 709-6195.

There are 3 infants during today’s inspection. LPA discussed Safe Sleep Regulations with licensee. There is 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. Licensee documents sleep checks to include any signs of distress, 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 on 809C

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: MASSEY, DAWNA FAMILY CHILD CARE
FACILITY NUMBER: 103910292
VISIT DATE: 12/08/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with the immunizations. Licensee completed the Mandated Reporter Training on 01/20/22. Licensees’ pediatric CPR/First Aid expires on 05/18/23. Currently Licensee has one employee as a qualified assistant complete with immunization records on file for influenza, pertussis and measles. Licensee has all required immunizations.

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 inspections 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 MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2