503911783-5-22-2023-04-CC-ATRN-CS3S55-20230522133346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503911783
Report Date: 05/22/2023
Date Signed: 05/22/2023 01:34:02 PM

Document Has Been Signed on 05/22/2023 01:34 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	GOSS, ASHTYN FAMILY CHILD CARE		FACILITY NUMBER:	503911783
ADMINISTRATOR:	GOSS, ASHTYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 303-7916
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 14	DATE:	05/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Ashtyn Goss		TIME COMPLETED:	01:45 PM

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On 5/22/2023 at 11:50am Licensing Program Analyst (LPA) Anita Tristan, conducted an unannounced Annual Required Inspection and was met by Licensee, Ashtyn Goss. Also present were Staff #1 And Staff #2. Days and hours of operation are Monday-Friday 6:00am-6:00pm. The home has working telephone service and LPA confirmed the phone number is (209) 303-7916.

LPA toured the home inside and outside and a census was taken; there were 14 children in care. Current facility sketch reviewed and updated, and Licensee confirmed that the kitchen area is used for infants to nap only, and they have (3) play yards set up in kitchen area, bathroom and living room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible. The outdoor play area in the backyard is fenced and there are no hazards to children present. There is no swimming pool or other bodies of water on the premises. 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. Safe toys and play equipment are observed.

LPA discussed the safe sleep regulations with licensee

***Continue on 809-C***

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Anita Tristan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOSS, ASHTYN FAMILY CHILD CARE	FACILITY NUMBER: 503911783
	VISIT DATE: 05/22/2023

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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 01/15/2022. Licensee’s pediatric CPR/First Aid expires on 12/2023. 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) -Inhaler; is currently being provided for one child but has never had to use it. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

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

Exit interview conducted and report and appeal rights were reviewed and discussed with the facility representative Ashtyn Goss.

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

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Anita Tristan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

LIC809 (FAS) - (06/04)

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