503808989-10-29-2019-04-CC-AMEA-BHEU3S-20191029151402

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503808989
Report Date: 10/29/2019
Date Signed: 10/29/2019 03:14:07 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 II		FACILITY NUMBER:	503808989
ADMINISTRATOR:	DOMSON, HAZEL		FACILITY TYPE:	840
ADDRESS:	1528 OAKDALE RD		TELEPHONE:	(209) 521-4422
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	9	CENSUS: 0	DATE:	10/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Hazel Domson		TIME COMPLETED:	03:30 PM

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	An unannounced Annual/Random inspection was conducted today by Licensing Program Analysts (LPAs) Angelica Mejia and Luisa Gavoutian. LPAs met with Director Hazel Domson and toured the facility, both indoors and outdoors. There are no bodies of water on site. Firearms/weapons are not allowed or stored on premises. All children are under supervision, including visual supervision, at all times. Disinfectants, cleaning solutions and other dangerous items shall be inaccessible to children. Storage areas for poisons are locked. No poisons were observed during today’s visit. All materials and surfaces accessible to children are toxic free. All toilets and hand washing facilities are in safe and sanitary operating conditions. All floors are clean and safe. All kitchen, food prep, and storage areas are clean and free of litter, rubbish, and pests. All food is protected from contamination, and contaminated food is discarded immediately. All food and beverages capable of rapid spoiling are stored in covered containers at 45°(F) or less. Solid waste storage vessels, including moveable bins, have tight-fitting covers on and are in good repair. Uncontaminated drinking water is available both indoors and outdoors. Menus are posted at least one week in advance and are visible to authorized representatives. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Playground equipment is in good condition and free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings, and slides have cushioning material to absorb falls. (Continued on LIC809-C)

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica Mejia	TELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 II	FACILITY NUMBER: 503808989
	VISIT DATE: 10/29/2019

NARRATIVE

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CCL shall notify a licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption and have been associated to the facility. A review of personnel and children’s records was conducted. Staff records contain appropriate documentation of education credits. 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 is responsible for the child, uses their full legal signature and records the time of day. Child's admission agreement is available for review. Required CCL forms are posted on parent's board. Days and hours of operation are Monday – Friday; 06:00 AM – 07:00 PM.

This facility provides Incidental Medical Services (IMS). There are no children that currently require IMS. 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 at: http://www.ada.gov/childqanda.htm

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today. Site Visit Notice posted on the parent board. Exit interview was conducted with Hazel Domson.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Duane Matsubara	TELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica Mejia	TELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

LIC809 (FAS) - (06/04)

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