203911881-2-7-2023-04-CC-JYAZ-CNTUNS-20230207144424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203911881
Report Date: 02/07/2023
Date Signed: 02/07/2023 02:44:36 PM

Document Has Been Signed on 02/07/2023 02:44 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:	DIBLER, KELSEY FAMILY CHILD CARE		FACILITY NUMBER:	203911881
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/07/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Kelsey Dibler		TIME COMPLETED:	02:50 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 02/07/2023, Licensing Program Analyst (LPA), Jeovanna Yanez met with Applicant, Kelsey Dibler, for a pre-licensing inspection. Applicant, her husband, and three (3) minor children 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, one bathroom home and children will have access to the living room, kitchen, and hallway bathroom. Off-limits rooms are made inaccessible by use of plastic door knob covers. · There is no fireplace in the home. · In the living room, LPA observed: Children's toys, games, a flat screen TV mounted to the wall. Children and Infants will nap in the living room. 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 February 4, 2025 · Preventative Health and Safety with Prevention of Lead exposure certification was completed on June 3, 2022. (CONTINUED ON 809-C)

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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: DIBLER, KELSEY FAMILY CHILD CARE	FACILITY NUMBER: 203911881
	VISIT DATE: 02/07/2023

NARRATIVE

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· Knives and medications are stored in a top kitchen cabinet. Cleaning compounds are stored in a top hallway cabinet. Poisons are kept in the locked shed, kept under key lock.
· 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 are no bodies of water in the home or premises.
· There are four (4) dogs that are kept in kennels towards the side of the backyard. 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.
· Fenced backyard has a cemented area, sodded area and an area with dirt and gravel. LPA observed a patio porch for shade. There are tricycles, children size tables and chairs, and other safe toys for the day care children. There is a large, two-story wooden play structure, attached with a swing set. The ground level has a small wooden bench and a play kitchen, as well as a 4 foot wooden/plastic ladder on one side of the structure that leads to the second level. The second level has a small observation deck with access to a green plastic slide, as well as a yellow sliding pole. This play structure is anchored to the ground. LPA also observed a trampoline with a netted enclosure. (CONTINUED ON 809-C)

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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: DIBLER, KELSEY FAMILY CHILD CARE	FACILITY NUMBER: 203911881
	VISIT DATE: 02/07/2023

NARRATIVE

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· SB 792 immunizations verified and on file.
· Applicant completed the Mandated Reporter Training on July 7, 2022.
· LPA discussed safe sleep regulations and Safe Sleep Regulations 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 7:00 AM to 5:30 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.

Pending a final review of application file, licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended effective 02/08/2023.

SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC809 (FAS) - (06/04)

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