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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808989
Report Date: 09/19/2019
Date Signed: 09/19/2019 02:05:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HAZEL'S CHRISTIAN PRESCHOOL&CHILD CARE CENTER IIFACILITY NUMBER:
503808989
ADMINISTRATOR:DOMSON, HAZELFACILITY TYPE:
840
ADDRESS:1528 OAKDALE RDTELEPHONE:
(209) 521-4422
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:9CENSUS: 0DATE:
09/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Director - Hazel DomsonTIME COMPLETED:
02:15 PM
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Licensing Program Analysts, Luisa Gavoutian and Angelica Mejia, conducted an unannounced case management inspection today. LPAs met with Director Hazel Domson and toured the facility. No school age children were present today. There are no bodies of water at this facility. Firearms and ammunition are not permitted on the premises. Disinfectants, hazardous items and medications are inaccessible to children. Furniture and equipment are sufficient, age appropriate and in good repair. The playground equipment and outdoor activity space is maintained and in good condition with adequate cushioning material. Children's toilets and hand washing facilities are sanitary. Rooms are safe and clean. Drinking water is available both indoors and outside.

This facility does not provide Incidental Medical Services (IMS).

Hours of operation are 6:00 a.m. – 7:00 p.m.

A copy of this report must remain in the facility for public review.

No deficiencies were observed during today's visit.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
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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