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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103912215
Report Date: 02/08/2024
Date Signed: 02/08/2024 11:20:14 AM

Document Has Been Signed on 02/08/2024 11:20 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 RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:WINDOM,DAJA FAMILY CHILD CAREFACILITY NUMBER:
103912215
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/08/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Daja WindomTIME COMPLETED:
11:30 AM
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On 02/08/2024, Licensing Program Analysts (LPAs), Jeovanna Yanez and Monica Lopez met with Applicant, Daja Windom for a pre-licensing/change of location inspection. Applicant, her husband, and three minor children reside in the home. Background clearances are discussed and LIS 531/Roster Report were signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on January 12,2024.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
· Fire clearance was received on January 23, 2024. Fire pull alarm is located on the home’s entry way on the left hand side wall.
· On this date, 11/16/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.
· This is a single story three bedroom, two bathroom apartment home and children will have access to living room, dining room, kitchen, bedroom #1, and hallway bathroom. Off-limits rooms have not been made inaccessible. LPA did not observe a fireplace in the home.
(CONTINUED ON 809-C)
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: WINDOM,DAJA FAMILY CHILD CARE
FACILITY NUMBER: 103912215
VISIT DATE: 02/08/2024
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· Applicant’s Pediatric CPR and First Aid certification was completed through HSI Pediatric with Emergency Medical Services Authority stickers (EMSA) and expires on February 12, 2024.
· Preventative Health and Safety Course with Prevention of Lead exposure certification was completed on February 12, 2023.
· Applicant completed the Mandated Reporter Training on March 15, 2022
· SB 792 immunizations verified and on file.
· Applicant rents/leases the home, proof of landlord notification is required. LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. Applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 12 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 14 children.
· In the living room, LPA observed comfortable furnishings and flat screen television mounted on an entertainment stand. In bedroom #1 (play room), LPA observed a colorful alphabet rug, children size table, chairs, and furniture, a flat screen television mounted on the wall, and safe games, toys, and books for the children. Children will nap on cots, infants will nap on play yards in the living room. Applicant understands she is to supervise children at all times.
· Fenced back patio has cement for the children. There is a patio porch for shade. LPA observed a small plastic slide and other safe toys for the children.
· Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
· Knives are stored in a bottom kitchen drawer made inaccessible via safety latch. Medications are stored in a top kitchen cabinet. Cleaning compounds are stored in a top shelf in the hallway closet.
· There is an apartment swimming pool that is fenced per regulation. Applicant states that pool gate is kept locked at all times.
(CONTINUED ON 809-C)
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: WINDOM,DAJA FAMILY CHILD CARE
FACILITY NUMBER: 103912215
VISIT DATE: 02/08/2024
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· Applicant states there are no pets in the home or on the premises.
· Applicant states there are no firearms or ammunition in the home or premises.
· 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.
· 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 she will not be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information and-resources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA provided applicant with Individual Infant Sleeping Plan and Safe Sleep handout.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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
(CONTINUED ON 809-C)
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: WINDOM,DAJA FAMILY CHILD CARE
FACILITY NUMBER: 103912215
VISIT DATE: 02/08/2024
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Applicant was advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Applicant states she will operate her day care Monday through Friday from 7:00 am to 6:00 pm and as arranged. No overnight care will be provided.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities,
providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly
Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Applicant is advised the following items must be corrected and documentation be sent to Fresno CCL within the next 30 days to avoid possible withdraw.
· Applicant will make the master bedroom, and bedroom #2 inaccessible to daycare children.
· Applicant will make the following inaccessible: a washing machine and a drying machine located in the back patio. (CONTINUED ON 809-C)
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: WINDOM,DAJA FAMILY CHILD CARE
FACILITY NUMBER: 103912215
VISIT DATE: 02/08/2024
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Pending verification of corrections of the above items and a final review of her application, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended. Exit interview conducted and report was reviewed with applicant.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC809 (FAS) - (06/04)
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