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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 503911783
Report Date: 12/19/2023
Date Signed: 12/19/2023 11:00:08 AM

Unsubstantiated


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: 12DATE:
12/19/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ashtyn GossTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Lack of supervision which resulted with injury to daycare child
INVESTIGATION FINDINGS:
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On 12/19/2023 at 10:30 a.m., Licensing Program Analyst (LPA) Valerie Mireles conducted an unannounced complaint inspection to provide findings for the above allegation. LPA met with Licensee, Ashtyn Goss. LPA explained the allegations, toured the facility, inside and outside. A census was taken. LPA observed 12 children supervised by Licensee and one Assistant.

Complainant alleged that lack of supervision resulted in an injury to a daycare child. During the course of the investigation, LPA reviewed facility records, made observations, conducted interviews with the Complainant, Licensee, and the parents of children in care. LPA observed Licensee to be attentive to children in care. Due to inconsistent statements obtained, the information did not corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Continued to LIC809-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Valerie Mireles
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
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 2
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: 12/19/2023
NARRATIVE
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Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency is cited during today’s visit.

Exit interview conducted with the Licensee, Ashtyn Goss. Appeal rights were provided and discussed. A Notice of Site Visit was given and will be posted for 30 days.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Valerie Mireles
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2