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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701223
Report Date: 04/11/2022
Date Signed: 04/11/2022 04:23:51 PM

Document Has Been Signed on 04/11/2022 04:23 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HAZEL GOES COOK ELEMENTARY SCHOOLFACILITY NUMBER:
376701223
ADMINISTRATOR:GABRIELA LLAMASFACILITY TYPE:
850
ADDRESS:875 CUYAMACA AVENUETELEPHONE:
(619) 425-9600
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 48TOTAL ENROLLED CHILDREN: 41CENSUS: 20DATE:
04/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:Gabriela LlamasTIME COMPLETED:
12:45 PM
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On 4/11/2022, at 10:27am, Licensing Program Analyst (LPA) Martha Malane, conducted an unannounced Annual Inspection and met with Lead Teacher, Jackie Ramirez. LPA disclosed the purpose of the inspection and toured the facility indoors and outdoors. This is a hall day program which operates on a traditional school year schedule. Days and hours of operation are Monday – Friday 8:45am – 11:45am for the morning group and 12:45pm – 3:45pm for the afternoon group. There is currently one (1) classroom (room 1103) in operation. There were 20 children with four (4) staff present.

Lead Teacher stated there are no bodies of water on the premises and LPA did not observe any bodies of water on the premises. Lead Teacher stated there are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.

Furniture and equipment are in good condition. Playground equipment is in safe condition. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas under high climbing equipment have wood chips for cushioning. Toilets and hand-washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Facility has a functioning carbon monoxide detector that met statutory requirements. Meals and snacks are provided by the school district.

Lead Teacher stated all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions through the Chula Vista School District. See LIC809C continuation...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HAZEL GOES COOK ELEMENTARY SCHOOL
FACILITY NUMBER: 376701223
VISIT DATE: 04/11/2022
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off-site activities. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. Children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than eight (8) children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment.

This facility provides Incidental Medical Services (IMS). All medication is stored and administered by the nurse in the school office. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Lead Teacher, discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, California Megan’s Law (www.meganslaw.ca.gov), Forms and Regulations.

No deficiencies cited during today’s inspection.

The following forms will be submited to the Department by May 11, 2022:
· LIC200A – Update for capacity
· Notice of removing room 1102
· LIC999 – Updated facility sketch

See LIC809C continuation...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HAZEL GOES COOK ELEMENTARY SCHOOL
FACILITY NUMBER: 376701223
VISIT DATE: 04/11/2022
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A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Lead Teacher, Jackie Ramirez.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
LIC809 (FAS) - (06/04)
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