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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163901684
Report Date: 12/05/2024
Date Signed: 12/05/2024 11:03:07 AM

Document Has Been Signed on 12/05/2024 11:03 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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MOMBERGER, DAWN FAMILY CHILD CAREFACILITY NUMBER:
163901684
ADMINISTRATOR/
DIRECTOR:		MOMBERGER, DAWNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 904-6906
CITY:LEMOORESTATE: CAZIP CODE:
93245
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
12/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:47 AM
MET WITH:Dawn MombergerTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On December 5, 2024, Licensing Program Analyst (LPA), Paul Garcia conducted an unannounced Annual Random Inspection and was met by Licensee, Dawn Momberger. Also present was a background cleared assistant. Days and hours of operation are Monday-Friday from 7:00 AM -5:30 PM. The home has working telephone service and LPA confirmed the phone number is (559) 904-6906.

LPA toured the home inside and outside and a census was taken. A current facility sketch was reviewed, and Licensee confirmed that living room, bathroom, and playroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of child safety gates. The outdoor play area in the backyard is fenced and is off limits to children in care. There are three dogs that live on the property. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. LPA Garcia advised licensee that Effective January 1, 2025, all childcare facilities licensed by CCL by law will be required to adhere to AB2866 - The Pool Safety Act. According to Health & Safety Code 1596.814, additional safety features will be required, which are listed in AB2866. A full text of AB2866 is available in the attached link: https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB2866 . Additional information will be provided in an upcoming PIN and available on the Department’s website at

No windows or doors have direct access to the pool area. Per licensee, there are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home as this is a single level home. Safe toys and play equipment are observed.

SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MOMBERGER, DAWN FAMILY CHILD CARE
FACILITY NUMBER: 163901684
VISIT DATE: 12/05/2024
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LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on September 27, 2024. Licensee’s pediatric CPR/First Aid expires on April 27, 2026. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption.

There are no excluded individuals present at this home. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) are not currently being provided. (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. 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm)

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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 SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MOMBERGER, DAWN FAMILY CHILD CARE
FACILITY NUMBER: 163901684
VISIT DATE: 12/05/2024
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LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request.

An exit interview was conducted, and this report was reviewed with the facility representative Dawn Momberger. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the home.

A notice of site visit was issued and must remain posted for 30 days.

SUPERVISORS NAME: Gloria Reyes
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
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