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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 503911783
Report Date: 11/07/2023
Date Signed: 11/07/2023 04:57:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/01/2023 and conducted by Evaluator Valerie Mireles
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20231101104222
FACILITY NAME:GOSS, ASHTYN FAMILY CHILD CAREFACILITY NUMBER:
503911783
ADMINISTRATOR:GOSS, ASHTYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 303-7916
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 15DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Ashtyn GossTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Licensee operating over capacity.
INVESTIGATION FINDINGS:
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On 11/07/2023, Licensing Program Analyst (LPA) Valerie Mireles conducted an unannounced complaint inspection. The purpose of the inspection was to open the complaint and deliver investigation findings. Upon arriving, LPA took a census and observed 15 children consisting of three infants, 10 preschool children and two school-age children in care supervised by Licensee’s two assistants. Licensee was not initially present; however, arrived approximately 45 minutes later. LPA met with Licensee and explained the allegations. LPA toured the facility, interviewed staff, reviewed facility records and took photos.
This agency investigated the complaint alleging staff are operating over capacity. During the investigation, LPA visually observed 15 children in care, which is above the capacity of the License. Based upon LPA Mireles’ observations and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation; Licensee operating over capacity, is found to be SUBSTANTIATED.
Per California Code of Regulations, Title 22, Division 12, Chapter 3, this deficiency is cited on the attached LIC 9099-D. Continued to LIC9099-C.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Valerie Mireles
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 04-CC-20231101104222
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOSS, ASHTYN FAMILY CHILD CARE
FACILITY NUMBER: 503911783
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/10/2023
Section Cited
CCR
102416.5(a)
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Staff Ratio & Capacity (a)The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.This requirement was not met as evidenced by: LPA findings during investigation of complaint. This poses an immediate risk to the health, safety, and personal rights of children in care.
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Licensee to write a statement as to how she will plan to maintain license limit for children in care at all times. Licensee stated that parents are aware that she shall maintain capacity. Plan of correction to be submitted to CCL office by 11/10/2023.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Valerie Mireles
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 04-CC-20231101104222
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GOSS, ASHTYN FAMILY CHILD CARE
FACILITY NUMBER: 503911783
VISIT DATE: 11/07/2023
NARRATIVE
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An exit interview conducted with Ashtyn Goss. Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Licensee. A copy of this report and Appeal Rights were provided and discussed with Ashtyn Goss.

A Notice of Site Visit Form was posted to parent's board and must remain posted.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Valerie Mireles
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3