503911354-11-25-2020-04-CC-NLOI-BVPR5U-20201125114343

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503911354
Report Date: 11/25/2020
Date Signed: 11/25/2020 11:43:55 AM

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:	BRYAN, TREAVIONA FAMILY CHILD CARE		FACILITY NUMBER:	503911354
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	11/25/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Treaviona Bryan		TIME COMPLETED:	11:50 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	Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On November 25, 2020, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Treaviona Bryan for a pre-licensing inspection. Applicant and her two minor children reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: This is a single story, two bedrooms and two bathrooms duplex home and children will have access to the living room, dining room, kitchen and hallway bathroom. Off-limits rooms are made inaccessible by use of plastic door knob covers and child proof safety gates. There is a fireplace in the living room that applicant states it will not be used during day-care hours. LPA observed children size furniture, safe toys, arts and crafts supplies, instructional materials and books for the day care children. There is a parents board on the home's entry way wall. Children will nap in the living room mats. An infant will nap in a crib. Applicant understands she is to supervise children at all times. Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place. Applicant’s Pediatric CPR and First Aid certification was completed through American Heart Association and expires on November 14, 2022. Preventative Health and Safety class was completed on August 24, 2020. (Continued on LIC809-C):

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020

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: BRYAN, TREAVIONA FAMILY CHILD CARE	FACILITY NUMBER: 503911354
	VISIT DATE: 11/25/2020

NARRATIVE

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Knives are stored on top of the refrigerator inside the knives block and inside a plastic container. Medications are stored inside a top kitchen cabinet that is made inaccessible by the use of a child proof safety latch. Cleaning compounds are stored inside the cabinet that is located underneath the kitchen sink that is made inaccessible by the use of a child proof safety latch. Other cleaning compounds are stored in the inaccessible garage.
Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
There are no bodies of water in the home or premises.
Applicant states there are no pets in the home or on the premises.
Firearms are stored in accordance with Title 22 Regulations and ammunition is stored separate in accordance with Title 22 Regulations.
Poisons are stored inside a key locked plastic container that is located in the garage.
Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
Applicant states that she will not be transporting day care children. Applicant understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
Fenced backyard has artificial turf foundation. There are balls, a Little Tikes toddler slide, a Step 2 Kitchenette and a empty water table for the day care children. LPA observed a My 1st Trampoline with a netted enclosure. Applicant is advised that she must follow the manufacture's guidelines when allowing day care children to use the small trampoline. There is also patio furniture and a gazebo for shade.

(Continued on LIC809-C):

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020

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: BRYAN, TREAVIONA FAMILY CHILD CARE	FACILITY NUMBER: 503911354
	VISIT DATE: 11/25/2020

NARRATIVE

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SB 792 immunizations verified and on file.
Applicant completed the Mandated Reporter Training on October 29, 2020.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 6:00 AM to 6:00 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant 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.

Licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended effective November 30, 2020.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma Lomeli	TELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020

LIC809 (FAS) - (06/04)

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