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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393609094
Report Date: 09/06/2019
Date Signed: 09/06/2019 09:28:44 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:WALKER, HAZEL & WARREN, SHIRLEYFACILITY NUMBER:
393609094
ADMINISTRATOR:WALKER, HAZEL LEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 932-9030
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:14CENSUS: 2DATE:
09/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Hazel Walker & Shirley WarrenTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Chayntel Hunter met with Licensees Hazel Walker and Shirley Warren for the purpose of an unannounced annual random inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Census at the time of inspection was 2 children.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include: entire upstairs, laundry room and garage. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. There is a waiver on file for the fountain in the front yard. Toxic and hazardous items are inaccessible to children. LPA observed a fireplace that was covered by a screen. Outdoor play space is fenced. The play equipment appears to be in good repair.

Children's file were reviewed. Emergency information and required immunization records were on file. LPA observed a current roster and documentation that a fire drill is conducted at least once every six months. Licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires 12/2019 and Child Care Provider Mandated Reporter was verified and expires 10/2020. This provider is not currently providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed.

LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Licensee can request to be added to the distribution list to receive Quarterly Updates. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures.

This facility evaluation report was reviewed and discussed with Licensee. A Notice of Site Visit was provided. In the areas that were evaluated, no deficiencies were observed at the time of the visit.

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019
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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