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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103902037
Report Date: 11/30/2023
Date Signed: 11/30/2023 10:23:07 AM


Document Has Been Signed on 11/30/2023 10:23 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, 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: 1DATE:
11/30/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sabrina Mortensen-LicenseeTIME COMPLETED:
10:35 AM
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On 11/30/2023, Licensing Program Analyst (LPA) Ka Vang conducted an unannounced Annual Required Inspection and was met by Licensee Sabrina Mortensen. Days and hours of operation are Monday through Friday, from 7:30 AM-5:30 PM. The home has a working telephone service and LPA confirmed the phone number is (559) 351-6501. Licensee stated that she provides breakfast, lunch, and snack for the daycare children throughout the day.

LPA toured the home inside and outside. Census was taken and there is one daycare children present. Current facility sketch (LIC 999A) was reviewed, and Licensee confirmed that the Great Room, Nook, Bedroom 12 x 16, Bedroom 11.5 x 11.5, Master Bedroom, and hallway restroom are used for providing childcare and accessible to the daycare children. All other rooms are off-limits and made inaccessible to the daycare children as all the doors are locked. There is a fireplace located in the living room but made inaccessible to the children by the use of a fire screen. Licensee stated that there are no firearms in the home. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are inaccessible.

This is a single level home and there are no stairs. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Fire drills are conducted and documented with the date, time and how many children present, every six months.

Safe toys and play equipment were observed and are in good condition, free of sharp, loose, or pointed parts. There is a dog in the home. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. The outdoor play area in the backyard is accessible to the children and is fenced and there are no hazards to children present. LPA observed a built-in swimming pool in the backyard which is fenced and made inaccessible. The pool gate is self-latching, self-closing and opens away from the swimming pool. No windows or doors have direct access to the pool area.

(Continued on LIC809-C).

SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MORTENSEN, SABRINA FAMILY CHILD CARE
FACILITY NUMBER: 103902037
VISIT DATE: 11/30/2023
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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 Child Care 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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.



Licensee did not have infants enrolled in the facility. Licensee understands that if licensee enroll infants in the facility, there shall be one play yard for each infant in care, the play yard is kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the play yard. Infants are not swaddled while in care. LPA advised licensee that she is required to observed sleeping infants every 15 minutes and document any sign of distress, which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing on a fifteen-minute sleeping log. Infants can be visually observed through an open door if sleeping in a separate room.

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. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter training was completed on 05/10/2023. Licensee’s pediatric CPR/First Aid expires on 03/2025. A review of records indicates that Licensee have immunization records on file for influenza, pertussis, and measles.

(Continued on LIC809-C).

SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MORTENSEN, SABRINA FAMILY CHILD CARE
FACILITY NUMBER: 103902037
VISIT DATE: 11/30/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.



Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 deficiency was cited during today’s inspection.

Licensee was provided a copy of appeal rights. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3