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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911993
Report Date: 10/05/2023
Date Signed: 10/06/2023 10:41:02 AM

Document Has Been Signed on 10/06/2023 10:41 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:BRYAN, TREAVIONA FAMILY CHILD CAREFACILITY NUMBER:
503911993
ADMINISTRATOR:BRYAN, TREAVIONAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 368-3054
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 11DATE:
10/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Treaviona BryanTIME COMPLETED:
04:00 PM
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On 10/05/2023, Licensing Program Analysts (LPAs) Miguel Herrera and Jeovanna Yanez arrived at the facility to conduct an unnanounced case management inspection. LPAs were greeted by Licensee,Treaviona Bryan, and a census was taken. Licensee's Assistant was also present during the inspection. The purpose of today's inspection is to provide technical assistance with record keeping and safe sleep regulations.

Upon arrival at the facility, LPA Herrera observed blankets in all four cribs in the infant room, and one crib had a DockATot pillow with a blanket. LPA Herrera did not see any infants in the cribs, and all infants were awake. Licensee stated the blankets where stored there while the infants played in the infant room. LPA Herrera asked about the DocATot pillow observed, and Licensee stated that it was used for her daughter’s baby doll when she plays at home. LPA Herrera discussed safe sleep regulations with Licensee and advised that all cribs and play yards should be free from all loose articles or objects. Licensee’s assistant immediately removed all items from inside the cribs. During nap time, LPA Herrera observed safe sleep accommodations. An advisory note was issued to discuss safe sleep regulations.

During record review, LPA Herrera observed some children’s files were missing or had incomplete required licensing forms. LPA Herrera advised Licensee to ensure that all required forms are completed and maintained in a file for each child enrolled in care. LPA Herrera reviewed form LIC 311D with Licensee and provided a copy of the form. An advisory note was issued to discuss recording keeping.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiency is being cited. Notice of Site Inspection to be 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
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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