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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911354
Report Date: 06/24/2021
Date Signed: 06/24/2021 12:31:46 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:BRYAN, TREAVIONA FAMILY CHILD CAREFACILITY NUMBER:
503911354
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
06/24/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:LicenseeTIME COMPLETED:
11:00 AM
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On 06/24/2021, Licensing Program Analyst (LPA) Angelica Mejia conducted a Licensee initiated case management tele-inspection. Due to COVID-19, LPA conducted a tele-inspection with Licensee Treaviona Bryan via Google Duo. The purpose of the inspection was to observe a new play structure Licensee recently installed in the backyard.

LPA observed one large, wood and plastic, three-level play structure. The ground level has a playhouse and two swings separated by a small bar swing with two handles. The second level has an approximately 4.5 feet high “rock” climbing wall leading up to the deck as well as a ladder. A side-by-side short, plastic, double slide exits on one side of the second level and a twisting tunnel slide exits on the opposite side. A three-step ladder leads from the second level up to the third level, which is an observation deck surrounded by an approximately 4-feet-high railing. Licensee showed LPA where the structure is anchored to the ground at five locations, per manufacturer instructions. Licensee shook the play structure at three different points and LPA observed it to be secured and sturdy. The play structure is recommended for children ages 3-10, up to 110 lbs weight limit per child. Licensee has the user’s manual and ensured that the manufacturer’s instructions will be followed.

LPA observed thick artificial turf used as cushioning underneath the entire play structure and backyard except for the small cemented patio area. LPA and Licensee discussed being cautious of the hot weather when allowing children to play outside as the metal and the plastic can get hot in the sun. Licensee stated they only go outside in the morning and they do not go outside when it is too warm. LPA advised for Licensee to conduct frequent safety inspections of the play structure to check for loose parts, cracks, and hazards.

Licensee is aware of child safety around the play structure and assumes all responsibility. Licensee understood that children must be supervised at all times while using the play structure. Licensee provided an updated facility sketch to LPA via email, which LPA printed and placed in the facility file. LPA approved the play structure for use effective today, 06/24/2021.


(Continued on LIC809-C)
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica MejiaTELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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: 06/24/2021
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited. An exit interview was conducted with Licensee and a copy of this report and appeal rights were provided via email. Licensee will send a copy of the report signed with her original signature to the Fresno Regional Office.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica MejiaTELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC809 (FAS) - (06/04)
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