<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911961
Report Date: 02/13/2023
Date Signed: 02/13/2023 03:16:19 PM

Document Has Been Signed on 02/13/2023 03:16 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 CAREFACILITY NUMBER:
103911961
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Tessa MizeTIME COMPLETED:
03:20 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 02/13/2023, A second announced pre-licensing inspection was conducted today by Licensing Program Analyst (LPA), Jeovanna Yanez. Met with Applicant, Tessa Mize. Applicant, her husband, her adult daughter and one minor child reside in the home..

The purpose of today's inspection is to verify that the following corrections requested were made. LPAs observed the following corrections during today's inspection:
· Applicant made the section of the fence that swung into the pool, swing away from the pool, meeting Title 22 Regulations.
· Applicant has scheduled to renew the Preventative Health and Safety course on February 24, 2023.

Provisional License for a Small Family Day Care Home capacity of 8 children ages under 18 years will be issued for 90 days, pending receipt of the Preventive Health and Safety Training certification. Provisional license will be effective 02/14/23.



Planned hours of operation are Monday through Friday from 6:30 am to 4:00 pm and as arranged. No overnight care will be provided.
SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2023
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 1