503911783-3-28-2024-04-CC-VMIS-D3SULS-20240328154113

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503911783
Report Date: 03/28/2024
Date Signed: 03/28/2024 03:41:26 PM

Document Has Been Signed on 03/28/2024 03:41 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 RO, 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: 13	DATE:	03/28/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Ashtyn Goss - Licensee		TIME COMPLETED:	04:00 PM

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On 03/28/2024, Licensing Program Analyst (LPA) Valerie Mireles conducted an unannounced Annual Required Inspection and was met by licensee Ashtyn "Rachelle" Goss. Also present were licensee’s two assistants. A census was taken and there were 13 children present during naptime. Capacity as specified on the license is being maintained. LPA toured the home inside and outside. Days and hours of operation are Monday- Friday 6:00 a.m. to 6:00 p.m.

LPA reviewed current facility sketch and confirmed that the daycare room and hallway bathroom are used for providing care. The kitchen area is only used for napping infants and has one play yard set up. All other rooms are off-limits and made inaccessible by door knob spinners. Licensee states that 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 in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Licensee conducted the most recent fire safety drill 10/2023. This is a single level home. Safe toys and play equipment are observed. Licensee has child sized tables, chairs, craft stations and age-appropriate toys. The home has working telephone service and LPA confirmed the phone number is (209) 303-7916.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. The outdoor play area in the backyard is currently off-limits due to repairs and has been reported to Licensing. There is no swimming pool or other bodies of water on the premises. LPA reviewed a sample of children’s files and observed files were incomplete, missing the LIC 9224 Form from Type A deficiency cited on 11/07/2023. Licensee’s Mandated Reporter Training was completed on 02/1/2024. Licensee’s pediatric CPR/First Aid certification expires on 01/2026. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

Continued to LIC809-C.

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Valerie Mireles
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOSS, ASHTYN FAMILY CHILD CARE	FACILITY NUMBER: 503911783
	VISIT DATE: 03/28/2024

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LPA discussed the Community Care Licensing (CCL) website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed safe sleep regulations with licensee and discussed the CCL Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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

Exit interview conducted and report was reviewed with licensee Ashtyn "Rachelle" Goss. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA verified the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited. (see next page, 809 D) Licensee was provided appeal rights. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Valerie Mireles
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/28/2024 03:41 PM - It Cannot Be Edited

Created By: Valerie Mireles On 03/28/2024 at 03:23 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOSS, ASHTYN FAMILY CHILD CARE	FACILITY NUMBER: 503911783
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8595

Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services .Health and Safety Code Section 1596.8595 (c) A licensed child care facility or home shall .... This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that, during record review LPA observed that the children's files reviewed did not have the LIC9224 in files. Licensee acknowledged that she could not locate the signed forms, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/11/2024
	Plan of Correction
1 2 3 4	Licensee stated that they will have parents complete the LIC9224 document and submit it to CCL on or before POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Cynthia Brannon

LICENSING EVALUATOR NAME:

Valerie Mireles

LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC809 (FAS) - (06/04)

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