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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 155620241
Report Date: 11/16/2023
Date Signed: 11/16/2023 12:03:16 PM

Document Has Been Signed on 11/16/2023 12:03 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:DEGRAFFENREID, DANA FAMILY CHILD CAREFACILITY NUMBER:
155620241
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/16/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Dana DegraffenreidTIME COMPLETED:
12:10 PM
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On 11/16/23, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Dana Degraffenreid for a pre-licensing inspection. Applicant and her roommate 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, four bedrooms and two bathrooms home and children will have access to the living room, dining room, kitchen, bedroom #1 (play room/napping room), bedroom #3 (school age) and hallway bathroom. Off-limits rooms/ closets are made inaccessible by use of plastic door knob covers, and door knob covers child proof safety gates.
  • There is central air heating/cooling ventilation for safety and comfort.
  • LPA observed in the dining room; three high chairs and two toddler picnic tables for the children. There is a flat screen television mounted onto the living room wall. Also observed in bedroom #1; children size furniture, safe toys, a flat screen television mounted onto the wall and colorful foam mat flooring. In bedroom #3; there are three dual desks and a flat screen television mounted onto the wall. There is a diaper changing area in the hallway. Children will nap in bedroom #1 on mats. Applicant states that she will not be providing care for infants. She will only provide care for children ages two and up. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: DEGRAFFENREID, DANA FAMILY CHILD CARE
FACILITY NUMBER: 155620241
VISIT DATE: 11/16/2023
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  • 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 HIS- EMS Safety Emergency Medical Services Authority stickers (EMSA) and expires on 8/25/25.
  • Preventative Health and Safety with Prevention of Lead exposure certification was completed on 6/9/23.
  • Knives are stored inside the top kitchen cabinet above the refrigerator. Medications are stored inside the top cabinet located above the range hood. Cleaning compounds are stored in the inaccessible garage inside a storage cabinet. 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.
  • There are four dogs that will be kept in the inaccessible garage inside their kennels. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
  • Applicant states there are no firearms, ammunition or poisons in the home or premises.
  • 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 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.
  • Fenced backyard has a sodded and cemented area for the children.
(Continued on LIC809-C):
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: DEGRAFFENREID, DANA FAMILY CHILD CARE
FACILITY NUMBER: 155620241
VISIT DATE: 11/16/2023
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  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on 4/16/22.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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)/ (800) 514-0383.

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. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday, 24 hours a day and as arranged. "Overnight Care" means care being provided to children anytime between the hours of 6:00 PM and 6:00 AM. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered into care.

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.

Pending a final review of application file, licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended effective 11/20/23.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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