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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503604897
Report Date: 09/10/2024
Date Signed: 09/30/2024 08:23:49 AM

Document Has Been Signed on 09/30/2024 08:23 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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:KERVIN, SHANNONFACILITY NUMBER:
503604897
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
09/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Shannon KervinTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 09/10/2024 Licensing Program Analyst (LPA), Yesenia Fierro conducted an unannounced annual required inspection and was met by Licensee, Shannon Kervin, also present was assistant # 1. LPA explained the reason for the visit. The home has a working telephone service and LPA Fierro confirmed phone number. 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 confirmed days and hours operation are Monday through Friday from 7:00AM-5:00PM.

Licensee stated there are no pets or bodies of water in the home. Licensee stated there are firearms/ammunition in the home. Firearms and ammunition are stored and locked separately. During today’s inspection there were 3 infants in care, capacity as specified on the license is being maintained. A current facility sketch was reviewed, and Licensee confirmed that the kitchen, the dining room, hallway bathroom, living room, living room #2 and backyard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of baby gates and safety latches.

LPA Fierro toured the home inside and outside. This is a two-story home. The fireplace located in the living room #2 is made inaccessible by a glass door. Licensee stated that fireplace will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. LPA observed licensee test the smoke detector and carbon monoxide. Licensee understands to test both smoke detector and carbon monoxide periodically for functionality.

Licensee stated that all poisons are kept inside the garage and cleaning items are kept in the kitchen in a locked cabinet Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. During today’s inspection LPA observed the home to clean and orderly. LPA observed surfaces and area accessible to children to be clean and in serviceable condition. LPA observed the home to have age-appropriate toys, dramatic play equipment, and learning material for those in care.

SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Yesenia Fierro
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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: KERVIN, SHANNON
FACILITY NUMBER: 503604897
VISIT DATE: 09/10/2024
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The outdoor play area in the backyard is fenced and there are no hazards to children present. LPA observed the backyard to have an age-appropriate swing set, swing set is surrounded by mulch to help with couching. LPA also observed age-appropriate toys.

Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s Mandated Reporter Training was completed on 10/06/2023. Licensee’s pediatric CPR/First Aid expires on 11/2025. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis, and measles.

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.

LPA observed Licensee is caring for infants. Licensee has one crib, play yard, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. License stated that infants are not swaddled while in care. Licensee physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

LPA discussed the safe sleep regulations with licensee and discussed the Childcare Licensing 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 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.

SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Yesenia Fierro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: KERVIN, SHANNON
FACILITY NUMBER: 503604897
VISIT DATE: 09/10/2024
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Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://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 childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Shannon Kervin confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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 Childcare 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

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

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Shannon Kervin.

SUPERVISORS NAME: Kari McWilliams
LICENSING EVALUATOR NAME: Yesenia Fierro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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