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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 503911993
Report Date: 11/28/2023
Date Signed: 11/28/2023 03:20:38 PM

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: 9DATE:
11/28/2023
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Treaviona BryanTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Provider is forging day care children's personal information on CCL documents.
INVESTIGATION FINDINGS:
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On 11/28/23, Licensing Program Analysts (LPA) Miguel Herrera conducted an unannounced inspection to conclude the complaint investigation that was received on 10/03/2023. LPA met with Licensee, Treavonia Bryan and discussed the purpose of the inspection and investigation findings. A tour of the home was conducted both inside and outside and census were taken.
During the course of the investigation, LPA interviewed and obtained information from licensee, staff, and parents. LPA also conducted a facility record review and obtained complete attendance records that were submitted by Licensee Bryan for payment of childcare services. A review of the licensee’s attendance records showed discrepancies in the attendance of daycare children. The investigation revealed through evidence obtained that licensee knowingly submitted attendance records that had inaccurate information.
Per Licensee’s own statement, facility records and interviews, child #1’s last day enrolled was on 09/26/2023, but upon attendance review LPA Herrera observed records with signatures stating that child #1 attended daycare on 09/27/2023 and 09/29/2023 which was untrue.
To be continued on 9099-C.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Miguel Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
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: 11/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/28/2023
Section Cited
HSC
1596.885(c)
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Conduct Inimical Health and Safety Code Section 1596.885(c): Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state.
This requirement was not met as evidenced by:
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Licensee states she will contact the Resource and Referral Agency to schedule a training course on how to properly document attendance records by 11/29/2023. The licensee will also write a statement documenting what she learned and how she will incorporate the training to her facility. The training should be completed by 12/22/2023.
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Based on LPA’s observation, interviews, and records review, the licensee knowingly submitted inaccurate attendance records that were contradictory to licensee’s statements and facility records, which poses an immediate personal rights, health, and safety risk to children in care
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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: 11/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
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: 11/28/2023
NARRATIVE
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Furthermore, LPA Herrera observed a discrepancy on 09/18/2023 as licensee submitted attendance records stating child #1 attended daycare, however through interview and evidence obtained LPA Herrera concluded child #1 did not attend daycare on 09/18/2023.

Per Licensee’s own statement, facility records and interviews, infant #7’s last day enrolled was on 09/27/2023, but upon attendance review LPA Herrera observed records with parent signature to state infant #7 attended daycare on 09/29/2023 which was untrue.

Per Licensee’s own statement and facility records, infant #3 was enrolled on 09/25/2023, but upon attendance review LPA Herrera observed records with parent signatures to indicate infant #3 attended daycare since 09/05/2023 which was contrary to Licensee’s statement and facility records.

Furthermore, through interviews LPA Herrera gathered enough information that indicated Licensee Bryan directed or allowed parents to sign in children on days that children did not attend daycare, therefore the attendance records did not reflect the actual attendance of children in care.

Based upon record review, observations, and information gathered through interviews, the preponderance of evidence standard has been met, the licensee’s conduct was inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state. Therefore, the above allegation is found to be substantiated.

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 deficiency is being cited: (See LIC 9099-D). Licensee Brayn 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: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3