390317630-3-4-2020-53-CC-FDIZ-BMDRAB-20200304115051

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 390317630
Report Date: 03/04/2020
Date Signed: 03/04/2020 11:50:58 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	HAZELTON ELEMENTARY SCHOOL		FACILITY NUMBER:	390317630
ADMINISTRATOR:	RAY SCHRAM		FACILITY TYPE:	850
ADDRESS:	535 W. JEFFERSON		TELEPHONE:	(209) 944-4212
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95206
CAPACITY:	46	CENSUS: 36	DATE:	03/04/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Linda DeLacy		TIME COMPLETED:	12:00 PM

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Licensing Program Analyst (LPA) Fabiola Diaz and Licensing Program Manager (LPM) Jeanne Smith met with head teacher Linda DeLacy at 9:00 A.M. for the purpose of an unannounced annual random inspection. Head teacher was reminded never to exceed the conditions, limitations and capacity specified on the license. Upon arrival LPA observed 16 children supervised by a fully qualified teacher and two assistants in G7. At 9:15 AM LPA observed 20 children supervised by a fully qualified teacher and two assistants in G3. Facility hours of operation for G7 is Monday through Friday 8:00 to 11:30 A.M. and for G3 is Monday through Friday 8:00 to 11:30 A.M. and 12 to 3:30 P.M. G7 and G3 is one room partitioned by a wall.

LPA toured all activity and classroom spaces, restrooms, and outdoor play areas. Head teacher stated there are currently no children using medications. Head teacher stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Toileting facilities are in safe, sanitary, and operating condition. Storage containers with solid waste have tight-fitting covers. At 9:30 A.M. LPA observed that playground equipment and surfaces are free of loose or sharp parts. Program provides breakfast and lunch. Food is brought in from the school cafeteria from SUSD. Menus were posted and drinking water was readily available to children. LPA observed at 9:45 A.M full legal signatures while reviewing the sign-in and sign-out sheet.

At 10:15 A.M. 5 staff and 10 children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 9/2020).

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: HAZELTON ELEMENTARY SCHOOL	FACILITY NUMBER: 390317630
	VISIT DATE: 03/04/2020

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All staff currently employed with the facility have a criminal record clearance, health screening report, mandated reporter certificates, and documentation of the educational background, training, and/or experience. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector in the building. LPA reviewed the Department's inspection authority and discussed with head teacher any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Incidental Medical Services (IMS) policy was discussed. IMS is provided by this facility. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available athttp://www.ada.gov/childqanda.htm.

LPA provided and discussed Effects of Lead Exposure brochure. Head teacher was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

In the areas that were evaluated, no deficiencies were observed at the time of the visit. An exit interview was conducted. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. A copy of this report and appeal right were discussed and left with head teacher, whose signature on this form confirms receipt of these documents

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020

LIC809 (FAS) - (06/04)

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