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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625221
Report Date: 09/18/2023
Date Signed: 09/18/2023 03:05:02 PM

Document Has Been Signed on 09/18/2023 03:05 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MESA, BRITTNEYFACILITY NUMBER:
343625221
ADMINISTRATOR:MESA, BRITTNEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 472-5099
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/18/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Brittney MesaTIME COMPLETED:
09:35 AM
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
This is a Change of Location from previous facility number 343623147

Licensing Program Analyst (LPA) Erwina Pascual-Golamco conducted a Change of Location inspection, and a follow up on the pool requirement/s before issuing a license:
*fencing that completely surrounds the pool that is at least 5 feet high and no window access.
LPA met with applicant Brittney Mesa. There were no other adults or children in the home during the inspection. Fire clearance was granted on 08/29/23. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant plans to operate Monday through Friday from 6:30 AM to 5:30 PM.

Applicant informed LPA that she had new pool fencing installed on 9/16/23 following the Tittle 22 Requirements. As of 9/18/23, LPA observed that the fencing completely surrounds the pool with no window access, is at least 5 feet tall, and meets Tittle 22 requirements for bodies of water. LPA received Applicant Bodies of Water Checklist.

Effective date: 09/19/23, Applicant is licensed as a large family child care home to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years. When there is no assistant present, then it will fall back to the small family child care home capacity.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2023
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