503808989-5-10-2021-04-CC-JMOA-C2VSGN-20210510135209

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503808989
Report Date: 05/10/2021
Date Signed: 05/10/2021 01:52:13 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: 6	DATE:	05/10/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Hazel Delphine Domson		TIME COMPLETED:	11:30 AM

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On 05/10/2021, Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an announced Case Management inspection and met with Site supervisor, Hazel Domson. LPA explained the reason of the inspection and a tour of the center was conducted both inside and outside. The center is located on the premises of Saint Pauls Church on 1528 Oakdale Rd in Modesto, CA. Licensee has added an additional school age classroom (8) and is wanting to increase their school age capacity from 9 children to 14 children ages 6-12 years. LPA observed a total of 6 school age children under the supervision of one staff member. This program will operate year round from Monday thru Friday from 6:00 AM to 7:00 PM.

The center provides 2 snacks. Parents are required to bring their children food. Licensee has a plan in place in case parents forget to bring their child food. Staff will utilize the private girls staff bathroom located in the parish hall where the school age (boys) bathrooms are located. Ill children will be isolated in the site supervisors office and use the staff bathroom. The classrooms were observed to be clean and free of toxins. The cleaning items/supplies will be stored up high in the cabinets, which will be inaccessible to children. The other cleaning items will be stored in a locked shed outside the classroom. LPA observed that the furniture and equipment appeared to be safe and in good condition. There are plenty of age appropriate items, tables, chairs, & cubby space to meet the requested capacity.

Room measurements were taken and reviewed with Mrs. Domson. The total inside School Age Area measured to an approximate 510 square feet which will accommodate the requested school age capacity. There is adequate storage space available for children's belongings. Toys and equipment appeared to be age appropriate. There is a total of 3 toilets, 3 urinals, and 4 sinks/hand washing fixtures available to the school age children. Licensee has a waiver in place that allows the preschool children to use those bathrooms as well. Staff understand that children should not be commingled inside the bathroom. Mrs. Domson stated that the classrooms will use water jugs and disposable cups for drinking water both indoor and outdoor.

Report Continued Onto LIC 809-C

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

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: 05/10/2021

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The playground has a fence that goes all around. There are 2 sheds for storage which are remained closed and locked at all times. LPA observed plenty of age appropriate toys, a bike path for children to play, grass, and mature trees that provide shade. Nothing in the play yard has changed so the same measurements are being used from the case management conducted on 6/21/2017. The outside play area measured to an approximate square footage of 8,037 Square feet which accommodates the School Age Capacity of 14 children. There is a waiver in place that allows the preschool children to share the play area with the school age children at separate times. LPA reminded licensee to make sure they have visual supervision of children at all times.

A fire clearance for 71 children was received and granted by the Modesto Fire Department on 10/03/2020. A new fire clearance will be sent out to meet the newly requested capacity.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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 at: http://www.ada.gov/childqanda.htm

The following items must be completed prior to issuing a license by 05/24/2021.

Corrections:

Repair or remove dome in preschool yard.
Repaint play items since rust is showing in playground.
LIC 610 - Emergency Disaster Plan.

Pending a final file review and completion of above items, a recommendation will be made to license the above facility for a capacity of 14 school age children.

No deficiencies cited during today's visit.
A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal Moctezuma	TELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

LIC809 (FAS) - (06/04)

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