103911961-2-10-2023-04-CC-JYAZ-CNWRLA-20230210120648

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103911961
Report Date: 02/10/2023
Date Signed: 02/10/2023 12:07:02 PM

Document Has Been Signed on 02/10/2023 12:07 PM - 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:	MIZE, TESSA FAMILY CHILD CARE		FACILITY NUMBER:	103911961
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/10/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Tessa Mize		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 02/10/2023, Licensing Program Analyst (LPA), Jeovanna Yanez met with Applicant, Tessa Mize, for a pre-licensing inspection. Applicant, her husband, her adult daughter and one minor child reside in the home. 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 or exemption. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: · This is a single story three bedroom, three bathroom home and children will have access to the daycare room, bathroom, kitchen and family room. Off-limits rooms are made inaccessible by use of safety gates. plastic door knob covers, or door latches. · There is a fireplace in the family room that applicant states will not be used during day-care hours. · In the daycare room, LPA observed safe toys, board games and books for the children. Children will nap in the daycare room on mats. Infants will nap in crib or play yards. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout. · Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place. · Applicant’s Pediatric CPR and First Aid certification was completed through HSI Pediatric with Emergency Medical Services Authority stickers (EMSA) and expires on November 19, 2022. · Preventative Health and Safety with Prevention of Lead exposure certification needs to be updated. (CONTINUED ON 809-C)

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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: MIZE, TESSA FAMILY CHILD CARE	FACILITY NUMBER: 103911961
	VISIT DATE: 02/10/2023

NARRATIVE

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· Applicant completed the Mandated Reporter Training on November 4, 2022.
· LPA discussed safe sleep regulations and Safe Sleep Concepts were given to applicant.
· Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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.

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. Applicant 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 6:30 am to 4:00 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 Fresno CCL within the next 30 days to avoid possible withdraw.
· Applicant will make one section of the fence swing away from the pool, meeting Title 22 Regulations.
· Applicant will complete the Preventative Health and Safety certification.

Pending verification of corrections of the above items and a final review of her application, licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended.

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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: MIZE, TESSA FAMILY CHILD CARE	FACILITY NUMBER: 103911961
	VISIT DATE: 02/10/2023

NARRATIVE

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· Knives and medications are stored in top kitchen cabinets made inaccessible with safety latches. Cleaning compounds are stored top and/or bottom cabinets in the kitchen, bathroom, and pantry made inaccessible with safety latches.
· 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/above ground pool that is fenced with a 6 foot wooden fence with one section that swings away from the pool and one section that swing inThe gate is self-latching/self-closing, swings away from the pool and latching device is located no more than six inches from the top of the gate.
· There is one dog that is kept on the gated side yard of the house. 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.
· 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 car restraints and/or car seats for all the children under her care when transporting children.
· LPA inspected the fenced backyard which will be off limits to the day care children. LPA observed a cemented area and various sheds. Prior to use, Applicant will contact Licensing to come clear backyard for day-care use.
· SB 792 immunizations verified and on file. (CONTINUED ON 809-C)

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

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