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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911354
Report Date: 05/04/2021
Date Signed: 05/04/2021 12:20:34 PM

Document Has Been Signed on 05/04/2021 12:20 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BRYAN, TREAVIONA FAMILY CHILD CAREFACILITY NUMBER:
503911354
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
05/04/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Treaviona BryanTIME COMPLETED:
12:30 PM
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On May 4, 2021, Licensing Program Analyst (LPA), Norma Lomeli conducted an inspection where facility will be operating under the Emergency Waiver. Present at time of inspection was licensee, five day care children and licensee's two minor children. Licensee and her two minor children reside in the home. Verified licensee’s CPR and First Aid was completed through American Heart Association and expires on November 14, 2022. Licensee’s Assistant, Rachel Durao has not completed the CPR and First Aid training. Licensee states that her assistant will not be left alone to provide care and supervision to the day care children. Background criminal record clearances are verified and discussed, and LIS 531 is signed indicating that the adults living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on April 19, 2021.

A tour of the home, inside and outside, as shown on the facility sketch, was conducted and the following was discussed and/or observed:
  • Fire clearance was received on April 19, 2021. Fire alarm is located on the home’s dining room wall.
  • LPA observed children size furniture, safe toys, arts and crafts supplies, instructional materials and books for the day care children. LPA observed a crib in the living room and a flat screen television mounted onto the wall. There is a parents board on the home's entry way wall.
  • Firearms are stored in accordance with Title 22 Regulations and ammunition is stored locked separate in accordance with Title 22 Regulations.
  • Poisons are stored inside a key locked plastic container that is located in the garage.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2021
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: 05/04/2021
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  • Facility has 2A10BC fire extinguisher, carbon monoxide alarm, working smoke alarm and first aid kit in place.
  • Licensee 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.
  • Licensee is advised that smoking is prohibited on the premises of a family chi care home as specified in Health and Safety Code Section 1596.795(a). Licensee states the home is smoke-free.
  • Licensee states she does transport day care children. Licensee understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
  • Required items are posted in the Child Care Home where parents may easily view.
  • During visit capacity worksheet was provided and discussed.
  • Licensee completed the Mandated Reporter Training on October 29, 2020. Licensee’s Assistant completed the training on January 1, 2021.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given licensee.

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

Licensee states her hours of operation are Monday through Friday from 6:00 AM to 6:00 PM and as arranged. Licensee advised she does not provide overnight care, less than 24 hours. Licensee is advised she may access forms and updated information on the CCLD website at www.ccld.ca.gov.

(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
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: 05/04/2021
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The home meets the description of a safe and healthy environment for children and is adequate to operate under the Emergency Waiver. Licensure to operate under the Emergency Waiver will be recommended effective May 5, 2021.

During exit interview, LPA observed licensee post the Notice of Site Visit on parent’s board and understands it must remain posted for 30 days and retain evaluation report for 3 years.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
LIC809 (FAS) - (06/04)
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