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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911528
Report Date: 06/19/2021
Date Signed: 06/19/2021 12:43:22 PM

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:ZITKOVICH, MARIO FAMILY CHILD CAREFACILITY NUMBER:
503911528
ADMINISTRATOR:ZITKOVICH, MARIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 620-3949
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:14CENSUS: 0DATE:
06/19/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Mario ZitkovichTIME COMPLETED:
01:00 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On June 19, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Mario Zitkovich for a prelicensing/change of location inspection. Applicant, his wife and their adult daughter reside in the home. Licensee’s Assistant, Karina Diaz completed the training through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on February 1, 2022. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on June 8, 2021.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on June 15, 2021. Fire alarm is located on the left hand side of the home’s entry way.
  • This is a two story, three bedrooms, an office/den and three bathrooms home and upstairs area will be off-limits to the day-care children. There is a gate at the bottom of the stairs making upstairs area inaccessible. Care and supervision will be provided in living room, family room, dining room, office/den and downstairs bathroom. Off limits rooms are made inaccessible by the use of a child proof safety gate.
  • LPA observed children size furniture, safe toys, and books for the children. There is colorful area rugs, a flat screen television mounted on to the wall, three high chairs and a parents board. LPA observed in the office/den a diaper changing table and a play yard. Infants will nap in play yards. Applicant understands she is to supervise children at all times.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021
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 4
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: ZITKOVICH, MARIO FAMILY CHILD CARE
FACILITY NUMBER: 503911528
VISIT DATE: 06/19/2021
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  • LPA observed children size furniture, safe toys, and books for the children. There is colorful area rugs, a flat screen television mounted on to the wall, three high chairs and a parents board. LPA observed in the office/den a diaper changing table and a play yard. Infants will nap in play yards. Applicant understands she is to supervise children at all times.
  • Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Applicant’s Pediatric CPR and First Aid certification was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on January 10, 2023.
  • Preventative Health and Safety class was completed on June 5, 2019.
  • Knives and medications are stored inside top kitchen cabinets. Cleaning compounds are stored inside the cabinet that is located underneath the kitchen sink. The cabinet is made inaccessible by the use of a child proof safety latch and a child proof safety gate.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
  • Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
  • There is an in-ground pool that is fenced with black rod iron fence in accordance with Title 22 Regulations. The gate is self-latching/self-closing and swings away from the pool.
  • There are two dogs that are kept accessible to the day care children. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
  • Applicant states there are no firearms or ammunition in the home or premises. Poisons are stored inside a shed that is kept under key lock and located in the backyard.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
  • Applicant states she will not be transporting day care children. Applicant understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021
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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ZITKOVICH, MARIO FAMILY CHILD CARE
FACILITY NUMBER: 503911528
VISIT DATE: 06/19/2021
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  • Fenced backyard has Step 2 playhouse, 2 Step 2 slide play structures, Step 2 sand table, Little Tikes basketball hoop, 2 Little Tikes Peddle and Go carts, tricycles and other safe toys for the children in care. There is a patio porch for shade.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on January 16, 2021. Applicant’s Assistant completed the training on January 19, 2021.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 7:00 AM to 5:00 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.



Applicant is advised the following items must be corrected and documentation be sent to CCL within the next 30 days to avoid possible withdraw.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ZITKOVICH, MARIO FAMILY CHILD CARE
FACILITY NUMBER: 503911528
VISIT DATE: 06/19/2021
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  • LPA observed that the black rod iron fence is not five feet high and the gate does not swing away from the in-ground pool. The in-ground pool fence and gate does not meet Title 22 Regulations.

Pending verification of corrections of the above items and a second prelicensing inspection, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4