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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 503911993
Report Date: 10/05/2023
Date Signed: 10/06/2023 10:45:58 AM

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
10/03/2023 and conducted by Evaluator Miguel Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20231003130134

FACILITY NAME:BRYAN, TREAVIONA FAMILY CHILD CAREFACILITY NUMBER:
503911993
ADMINISTRATOR:BRYAN, TREAVIONAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 368-3054
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 12DATE:
10/05/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Treaviona BryanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Provider does not check napping infants every 15 minutes.
Provider is operating beyond the scope of license.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Miguel Herrera and Jeovanna Yanez conducted an unannounced Inspection to initiate a complaint investigation alleging licensee not documenting infant sleep logs every 15 minutes and operating beyond the scope of the license.
Upon entry into the infant room LPA Herrera observed 4 infants in care (one infant was assistant’s child). LPA Herrera requested 15 minute sleep logs for all infants in care and upon observation LPA observed missing sleeping logs for 5 children. The 6th child had sleeping logs that were from last year (2022). LPA found further inconsonant logs during the inspection.
During the inspection Licensee received a fifth infant which put the home out of ratio. LPA Herrera observed 7 children and 5 infants in her care while documenting safe sleep during nap time.
Based on LPA's observations and interviews, it was determined that the facility did not document 15 minute safe sleep logs. It was also determined that licensee was operating out of ratio, and based on her statement it seemed like it happened when ever her assistants would come with their own children. Therefore, the preponderance of evidence standard has been met, and the allegations are found to be Substantiated.

Continued on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 04-CC-20231003130134
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: BRYAN, TREAVIONA FAMILY CHILD CARE
FACILITY NUMBER: 503911993
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/05/2023
Section Cited
CCR
102416.5(d)(1)
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For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under
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Licensee called parent to pick up infant and infant was picked up 20 minutes later. Licensee Stated that she will watch the video "HOW MANY CHIDLREN CAN ATTEND A FAMILY CHILD CARE HOME" and provide a statement to LPA explaining what they have learened and how they will ensure ratio is mainatined at all times.
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age 10, shall be either: (1) Twelve children, no more than four of whom may be infants. This requirement is not met as evidenced by: Based on observation licensee had 5 infants and 7 other chidlren in care which put the home out of ratio.
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Type B
10/20/2023
Section Cited
CCR
102425(j)(1)
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(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (1) The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by: Based on file review LPA observed inconsistant, missing and incomplete 15 minute safe sleep logs.
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Licensee will provide two weeks of 15 minute sleep logs for infants in care to Fresno RO by 10/19/2023. Licensee states she will talk to all her assistants about safe sleep and have them document safe sleep logs.
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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: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 04-CC-20231003130134
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: BRYAN, TREAVIONA FAMILY CHILD CARE
FACILITY NUMBER: 503911993
VISIT DATE: 10/05/2023
NARRATIVE
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Upon receipt of a Type A violation, 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 and a copy of LIC 9224 was given to licensee.
Per California Code of Regulations, Title 22, Division 12, Chapter 3, the following deficiencies are found: (See LIC 9099-D). Licensee was provided a copy of appeal rights. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4