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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103902037
Report Date: 03/10/2020
Date Signed: 03/10/2020 11:37:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MORTENSEN, SABRINA FAMILY CHILD CAREFACILITY NUMBER:
103902037
ADMINISTRATOR:MORTENSEN, SABRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 351-6501
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:14CENSUS: 0DATE:
03/10/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Sabrina MortensenTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Ginny Badhesha conducted an unannounced annual inspection and met with Licensee, Sabrina Mortensen. LPA explained the reason of the inspection and a tour of the home was conducted both inside and outside as shown on the facility sketches (LIC 999A). Present in the home was the Licensee. Licensee does not have any children enrolled at this time. Fireplace is screened and inaccessible to children in care. There are no stairs in the home. LPA observed plenty of age appropriate toys in the day-care room and observed that the house was clean and free of toxins. The knives and medications are stored up high in a cabinet. The chemicals and cleaning supplies are stored in the laundry room which is always kept locked. The backyard has a fence that goes all around. LPA observed a play structure and other age appropriate toys and there was plenty of shade. Licensee has no pets at this home. Licensee is current with the immunization requirements per SB 792. Licensee has taken the Mandated Reporter Training AB 1207 on 06/08/2019. Licensees CPR/First Aid certificate expires March 9, 2021. LPA spoke about the safe sleep regulations with Licensee and reminded her to not store anything inside the cribs and playpens. LPA also provided licensee with a safe sleep brochure and the new lead brochure. Licensee has a working fire extinguisher, carbon monoxide and smoke detector. There was adequate heating and ventilation for safety and comfort. Licensee stated that she does not have any guns or ammunition in the home. Swimming pool is fenced per regulation. There is a working telephone and number was verified. Capacity as specified on the license is being maintained.

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.

Days and hours of operation are Monday through Friday; 7:30am-5:30pm.

(Continued on 809-C)
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip BadheshaTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MORTENSEN, SABRINA FAMILY CHILD CARE
FACILITY NUMBER: 103902037
VISIT DATE: 03/10/2020
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited today.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

A Notice of Site Visit Form (LIC 9213) was posted on parent's board and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip BadheshaTELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
LIC809 (FAS) - (06/04)
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